|
HC CL TREAT VERTEBRAL BODY FX W/O
|
Facility
|
OP
|
$1,139.00
|
|
|
Service Code
|
CPT 22310
|
| Hospital Charge Code |
900501726
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$52.34 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
| Rate for Payer: Adventist Health Commercial |
$227.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$512.55
|
| Rate for Payer: Cash Price |
$512.55
|
| Rate for Payer: Cash Price |
$512.55
|
| Rate for Payer: Cigna of CA HMO |
$728.96
|
| Rate for Payer: Cigna of CA PPO |
$842.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$797.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$968.15
|
| Rate for Payer: Global Benefits Group Commercial |
$683.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$723.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$911.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$740.35
|
| Rate for Payer: Prime Health Services Commercial |
$968.15
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$683.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$569.50
|
| Rate for Payer: United Healthcare All Other HMO |
$569.50
|
| Rate for Payer: United Healthcare HMO Rider |
$569.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$569.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
|
|
HC CL TREAT WRIST FX, W/MANIPULAT
|
Facility
|
OP
|
$1,517.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
| Rate for Payer: Adventist Health Commercial |
$303.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Cigna of CA HMO |
$970.88
|
| Rate for Payer: Cigna of CA PPO |
$1,122.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,061.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$963.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$986.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$910.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$758.50
|
| Rate for Payer: United Healthcare All Other HMO |
$758.50
|
| Rate for Payer: United Healthcare HMO Rider |
$758.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
|
|
HC CL TREAT WRIST FX, W/MANIPULAT
|
Facility
|
IP
|
$1,517.00
|
|
|
Service Code
|
CPT 25680
|
| Hospital Charge Code |
900501574
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.40 |
| Max. Negotiated Rate |
$1,289.45 |
| Rate for Payer: Adventist Health Commercial |
$303.40
|
| Rate for Payer: Cash Price |
$682.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,061.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.80
|
| Rate for Payer: EPIC Health Plan Senior |
$606.80
|
| Rate for Payer: Galaxy Health WC |
$1,289.45
|
| Rate for Payer: Global Benefits Group Commercial |
$910.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$963.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$895.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.08
|
| Rate for Payer: Multiplan Commercial |
$1,213.60
|
| Rate for Payer: Networks By Design Commercial |
$986.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,289.45
|
|
|
HC CL TRT FEM FX W/O MANIP PE NCK
|
Facility
|
OP
|
$1,572.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Cigna of CA HMO |
$1,006.08
|
| Rate for Payer: Cigna of CA PPO |
$1,163.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$943.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.00
|
| Rate for Payer: United Healthcare All Other HMO |
$786.00
|
| Rate for Payer: United Healthcare HMO Rider |
$786.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$786.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TRT FEM FX W/O MANIP PE NCK
|
Facility
|
IP
|
$1,572.00
|
|
|
Service Code
|
CPT 27230
|
| Hospital Charge Code |
900501368
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$314.40 |
| Max. Negotiated Rate |
$1,336.20 |
| Rate for Payer: Adventist Health Commercial |
$314.40
|
| Rate for Payer: Cash Price |
$707.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,100.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$628.80
|
| Rate for Payer: EPIC Health Plan Senior |
$628.80
|
| Rate for Payer: Galaxy Health WC |
$1,336.20
|
| Rate for Payer: Global Benefits Group Commercial |
$943.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$998.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$927.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.28
|
| Rate for Payer: Multiplan Commercial |
$1,257.60
|
| Rate for Payer: Networks By Design Commercial |
$1,021.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,336.20
|
|
|
HC CL TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$125.21 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$617.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$583.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$486.00
|
| Rate for Payer: United Healthcare All Other HMO |
$486.00
|
| Rate for Payer: United Healthcare HMO Rider |
$486.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$486.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TRT FX GREAT TOE,W/MANIPUL
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 28495
|
| Hospital Charge Code |
900501249
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$826.20 |
| Rate for Payer: Adventist Health Commercial |
$194.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$680.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: EPIC Health Plan Senior |
$388.80
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$617.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$573.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.28
|
| Rate for Payer: Multiplan Commercial |
$777.60
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
IP
|
$2,857.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$571.40 |
| Max. Negotiated Rate |
$2,428.45 |
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,685.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
IP
|
$2,857.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$571.40 |
| Max. Negotiated Rate |
$2,428.45 |
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,142.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,142.80
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,685.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
OP
|
$2,857.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.27 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,828.48
|
| Rate for Payer: Cigna of CA PPO |
$2,114.18
|
| Rate for Payer: Adventist Health Commercial |
$571.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,428.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,428.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,428.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TRT MET FX W MANIPULATION EA
|
Facility
|
OP
|
$2,857.00
|
|
|
Service Code
|
CPT 28475
|
| Hospital Charge Code |
900501248
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$294.27 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,171.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,488.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cash Price |
$1,285.65
|
| Rate for Payer: Cigna of CA HMO |
$1,828.48
|
| Rate for Payer: Cigna of CA PPO |
$2,114.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,999.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$2,428.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,714.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,814.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$294.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$685.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$2,285.60
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,857.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,428.45
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,714.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,714.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CL TRT OF KNEE DISC W/O ANESTH
|
Facility
|
IP
|
$1,884.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$376.80 |
| Max. Negotiated Rate |
$1,601.40 |
| Rate for Payer: Adventist Health Commercial |
$376.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,448.80
|
| Rate for Payer: Blue Shield of California Commercial |
$955.19
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$753.60
|
| Rate for Payer: EPIC Health Plan Senior |
$753.60
|
| Rate for Payer: Galaxy Health WC |
$1,601.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,130.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,196.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,111.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.16
|
| Rate for Payer: Multiplan Commercial |
$1,507.20
|
| Rate for Payer: Networks By Design Commercial |
$1,224.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,601.40
|
|
|
HC CL TRT OF KNEE DISC W/O ANESTH
|
Facility
|
OP
|
$1,884.00
|
|
|
Service Code
|
CPT 27550
|
| Hospital Charge Code |
900501246
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$376.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cash Price |
$847.80
|
| Rate for Payer: Cigna of CA HMO |
$1,205.76
|
| Rate for Payer: Cigna of CA PPO |
$1,394.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,318.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,601.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,130.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,196.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$452.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,507.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$1,224.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,601.40
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,130.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$942.00
|
| Rate for Payer: United Healthcare HMO Rider |
$942.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$942.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CLUBFOOT WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
915353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC CLUBFOOT WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
915353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.53
|
| Rate for Payer: Blue Shield of California Commercial |
$76.90
|
| Rate for Payer: Blue Shield of California Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC CLUBFOOT WEDGE
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
905353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$20.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
|
|
HC CLUBFOOT WEDGE
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L3380
|
| Hospital Charge Code |
905353380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$85.00 |
| Rate for Payer: Adventist Health Commercial |
$41.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.53
|
| Rate for Payer: Blue Shield of California Commercial |
$76.90
|
| Rate for Payer: Blue Shield of California Commercial |
$50.70
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$85.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Senior |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$63.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.53
|
| Rate for Payer: United Healthcare All Other HMO |
$36.53
|
| Rate for Payer: United Healthcare HMO Rider |
$35.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
IP
|
$7,084.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,416.80 |
| Max. Negotiated Rate |
$6,021.40 |
| Rate for Payer: Adventist Health Commercial |
$1,416.80
|
| Rate for Payer: Cash Price |
$3,187.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,958.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,833.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,833.60
|
| Rate for Payer: Galaxy Health WC |
$6,021.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,250.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,498.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,179.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,700.16
|
| Rate for Payer: Multiplan Commercial |
$5,667.20
|
| Rate for Payer: Networks By Design Commercial |
$4,604.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,021.40
|
|
|
HC CMRI MORPH/FUNCT W/O CONTRAST
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
CPT 75557
|
| Hospital Charge Code |
908801260
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$306.88 |
| Max. Negotiated Rate |
$4,068.95 |
| Rate for Payer: Adventist Health Commercial |
$957.40
|
| Rate for Payer: Adventist Health Commercial |
$1,416.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,071.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,545.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,015.33
|
| Rate for Payer: Blue Shield of California Commercial |
$3,054.11
|
| Rate for Payer: Blue Shield of California Commercial |
$4,519.59
|
| Rate for Payer: Blue Shield of California Commercial |
$2,982.36
|
| Rate for Payer: Cash Price |
$2,154.15
|
| Rate for Payer: Cash Price |
$3,187.80
|
| Rate for Payer: Cash Price |
$2,154.15
|
| Rate for Payer: Cash Price |
$3,187.80
|
| Rate for Payer: Cigna of CA HMO |
$4,533.76
|
| Rate for Payer: Cigna of CA HMO |
$3,063.68
|
| Rate for Payer: Cigna of CA PPO |
$5,242.16
|
| Rate for Payer: Cigna of CA PPO |
$3,542.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,958.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,350.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$6,021.40
|
| Rate for Payer: Galaxy Health WC |
$4,068.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,872.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,250.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,498.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,039.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,737.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,571.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,148.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,700.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$5,667.20
|
| Rate for Payer: Multiplan Commercial |
$3,829.60
|
| Rate for Payer: Networks By Design Commercial |
$3,111.55
|
| Rate for Payer: Networks By Design Commercial |
$4,604.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,068.95
|
| Rate for Payer: Prime Health Services Commercial |
$6,021.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,250.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,872.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,250.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,872.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
IP
|
$7,552.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$1,510.40 |
| Max. Negotiated Rate |
$6,419.20 |
| Rate for Payer: Adventist Health Commercial |
$1,510.40
|
| Rate for Payer: Cash Price |
$3,398.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,286.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,020.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,020.80
|
| Rate for Payer: Galaxy Health WC |
$6,419.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,531.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,795.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,455.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,812.48
|
| Rate for Payer: Multiplan Commercial |
$6,041.60
|
| Rate for Payer: Networks By Design Commercial |
$4,908.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,419.20
|
|
|
HC CMRI MORPH/FUNCT W+W/O CONT
|
Facility
|
OP
|
$5,679.00
|
|
|
Service Code
|
CPT 75561
|
| Hospital Charge Code |
908801270
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$448.71 |
| Max. Negotiated Rate |
$4,827.15 |
| Rate for Payer: Adventist Health Commercial |
$1,135.80
|
| Rate for Payer: Adventist Health Commercial |
$1,510.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,644.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2,390.86
|
| Rate for Payer: Blue Shield of California Commercial |
$4,818.18
|
| Rate for Payer: Blue Shield of California Commercial |
$3,179.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,623.20
|
| Rate for Payer: Cash Price |
$3,398.40
|
| Rate for Payer: Cash Price |
$2,555.55
|
| Rate for Payer: Cash Price |
$3,398.40
|
| Rate for Payer: Cash Price |
$2,555.55
|
| Rate for Payer: Cigna of CA HMO |
$4,833.28
|
| Rate for Payer: Cigna of CA HMO |
$3,634.56
|
| Rate for Payer: Cigna of CA PPO |
$4,202.46
|
| Rate for Payer: Cigna of CA PPO |
$5,588.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,286.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,975.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$6,419.20
|
| Rate for Payer: Galaxy Health WC |
$4,827.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,407.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,531.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$606.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$606.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,606.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,795.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$685.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$685.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,812.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$565.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$6,041.60
|
| Rate for Payer: Multiplan Commercial |
$4,543.20
|
| Rate for Payer: Networks By Design Commercial |
$3,691.35
|
| Rate for Payer: Networks By Design Commercial |
$4,908.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,827.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,419.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,531.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,407.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,407.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,531.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare HMO Rider |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,367.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CMRI W FLOW/VEL QUANT W/O CONT
|
Facility
|
IP
|
$1,057.00
|
|
| Hospital Charge Code |
908801261
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC CMRI W FLOW/VEL QUANT W/O CONT
|
Facility
|
OP
|
$1,057.00
|
|
| Hospital Charge Code |
908801261
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$693.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$581.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$678.28
|
| Rate for Payer: Blue Shield of California Commercial |
$445.00
|
| Rate for Payer: Blue Shield of California Commercial |
$674.37
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$898.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$898.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$898.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$739.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$739.90
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.50
|
| Rate for Payer: United Healthcare All Other HMO |
$528.50
|
| Rate for Payer: United Healthcare HMO Rider |
$528.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$898.45
|
| Rate for Payer: Vantage Medical Group Senior |
$898.45
|
|
|
HC CMRI W FLOW/VEL QUANT W+W/O CO
|
Facility
|
IP
|
$1,057.00
|
|
| Hospital Charge Code |
908801271
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC CMRI W FLOW/VEL QUANT W+W/O CO
|
Facility
|
OP
|
$1,057.00
|
|
| Hospital Charge Code |
908801271
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$898.45 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$693.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$581.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$792.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$678.28
|
| Rate for Payer: Blue Shield of California Commercial |
$445.00
|
| Rate for Payer: Blue Shield of California Commercial |
$674.37
|
| Rate for Payer: Cash Price |
$475.65
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$898.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$898.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$898.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$671.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$383.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$739.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$739.90
|
| Rate for Payer: Multiplan Commercial |
$845.60
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$528.50
|
| Rate for Payer: United Healthcare All Other HMO |
$528.50
|
| Rate for Payer: United Healthcare HMO Rider |
$528.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$528.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$898.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$898.45
|
| Rate for Payer: Vantage Medical Group Senior |
$898.45
|
|
