|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,685.60 |
| Max. Negotiated Rate |
$9,511.50 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,481.25
|
| Rate for Payer: Blue Shield of California Commercial |
$8,258.22
|
| Rate for Payer: Blue Shield of California EPN |
$5,438.34
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,126.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,685.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,833.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.35
|
| Rate for Payer: Blue Shield of California Commercial |
$250.18
|
| Rate for Payer: Blue Shield of California EPN |
$164.75
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.36 |
| Max. Negotiated Rate |
$288.15 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$196.35
|
| Rate for Payer: Blue Shield of California Commercial |
$250.18
|
| Rate for Payer: Blue Shield of California EPN |
$164.75
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$227.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.36
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
IP
|
$637.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$541.45 |
| Rate for Payer: Adventist Health Commercial |
$127.40
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$254.80
|
| Rate for Payer: EPIC Health Plan Senior |
$254.80
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$242.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$394.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
OP
|
$637.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$127.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cash Price |
$286.65
|
| Rate for Payer: Cigna of CA HMO |
$407.68
|
| Rate for Payer: Cigna of CA PPO |
$471.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$541.45
|
| Rate for Payer: Global Benefits Group Commercial |
$382.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$509.60
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$414.05
|
| Rate for Payer: Prime Health Services Commercial |
$541.45
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$318.50
|
| Rate for Payer: United Healthcare All Other HMO |
$318.50
|
| Rate for Payer: United Healthcare HMO Rider |
$318.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$318.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.80 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: EPIC Health Plan Commercial |
$303.60
|
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: EPIC Health Plan Senior |
$303.60
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$289.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$469.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.24 |
| Max. Negotiated Rate |
$645.15 |
| Rate for Payer: Adventist Health Commercial |
$151.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$497.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.88
|
| Rate for Payer: Blue Shield of California Commercial |
$464.51
|
| Rate for Payer: Blue Shield of California EPN |
$306.64
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cash Price |
$341.55
|
| Rate for Payer: Cigna of CA HMO |
$485.76
|
| Rate for Payer: Cigna of CA PPO |
$561.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$645.15
|
| Rate for Payer: Global Benefits Group Commercial |
$455.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$506.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Networks By Design Commercial |
$493.35
|
| Rate for Payer: Prime Health Services Commercial |
$645.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$455.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$455.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC HAND LIMITED 2 VIEWS
|
Facility
|
OP
|
$756.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$495.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.38
|
| Rate for Payer: Blue Shield of California Commercial |
$462.67
|
| Rate for Payer: Blue Shield of California EPN |
$305.42
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: Cigna of CA HMO |
$483.84
|
| Rate for Payer: Cigna of CA PPO |
$559.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$604.80
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$453.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$453.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC HAND LIMITED 2 VIEWS
|
Facility
|
IP
|
$756.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$151.20 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$151.20
|
| Rate for Payer: Cash Price |
$340.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Senior |
$302.40
|
| Rate for Payer: Galaxy Health WC |
$642.60
|
| Rate for Payer: Global Benefits Group Commercial |
$453.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$467.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.44
|
| Rate for Payer: Multiplan Commercial |
$604.80
|
| Rate for Payer: Networks By Design Commercial |
$491.40
|
| Rate for Payer: Prime Health Services Commercial |
$642.60
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$95.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cigna of CA HMO |
$149.12
|
| Rate for Payer: Cigna of CA PPO |
$172.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.10
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.05
|
| Rate for Payer: Vantage Medical Group Senior |
$198.05
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$198.05 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$55.92 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$95.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cigna of CA HMO |
$149.12
|
| Rate for Payer: Cigna of CA PPO |
$172.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$163.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$163.10
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.05
|
| Rate for Payer: Vantage Medical Group Senior |
$198.05
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$198.05 |
| Rate for Payer: Adventist Health Commercial |
$46.60
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Senior |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$144.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.92
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
OP
|
$1,095.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$718.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$821.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.38
|
| Rate for Payer: Blue Shield of California Commercial |
$670.14
|
| Rate for Payer: Blue Shield of California EPN |
$442.38
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: Cigna of CA HMO |
$700.80
|
| Rate for Payer: Cigna of CA PPO |
$810.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$930.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$930.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$766.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$766.50
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$930.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$930.75
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
IP
|
$1,095.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.00 |
| Max. Negotiated Rate |
$930.75 |
| Rate for Payer: Adventist Health Commercial |
$219.00
|
| Rate for Payer: Cash Price |
$492.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.00
|
| Rate for Payer: EPIC Health Plan Senior |
$438.00
|
| Rate for Payer: Galaxy Health WC |
$930.75
|
| Rate for Payer: Global Benefits Group Commercial |
$657.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$730.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$677.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.80
|
| Rate for Payer: Multiplan Commercial |
$876.00
|
| Rate for Payer: Networks By Design Commercial |
$711.75
|
| Rate for Payer: Prime Health Services Commercial |
$930.75
|
|
|
HC HAPTOGLOBIN
|
Facility
|
OP
|
$105.26
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$124.22 |
| Rate for Payer: Adventist Health Commercial |
$21.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$124.22
|
| Rate for Payer: Blue Shield of California Commercial |
$70.42
|
| Rate for Payer: Blue Shield of California EPN |
$46.52
|
| Rate for Payer: Cash Price |
$47.37
|
| Rate for Payer: Cash Price |
$47.37
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$77.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.98
|
| Rate for Payer: EPIC Health Plan Senior |
$12.58
|
| Rate for Payer: Galaxy Health WC |
$89.47
|
| Rate for Payer: Global Benefits Group Commercial |
$63.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.86
|
| Rate for Payer: Multiplan Commercial |
$84.21
|
| Rate for Payer: Networks By Design Commercial |
$68.42
|
| Rate for Payer: Prime Health Services Commercial |
$89.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.19
|
| Rate for Payer: United Healthcare All Other HMO |
$10.19
|
| Rate for Payer: United Healthcare HMO Rider |
$10.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Vantage Medical Group Senior |
$12.58
|
|
|
HC HAPTOGLOBIN
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 83010
|
| Hospital Charge Code |
900910844
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
905350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,925.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,738.89
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cigna of CA HMO |
$2,854.40
|
| Rate for Payer: Cigna of CA PPO |
$3,300.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,791.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,676.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
905350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,699.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
915350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,925.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,453.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,345.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,738.89
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: Cigna of CA HMO |
$2,854.40
|
| Rate for Payer: Cigna of CA PPO |
$3,300.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,791.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,791.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,122.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,122.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,676.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,676.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,791.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,791.00
|
|
|
HC HARD PROTECT HELMET CUSTOM
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT A8003
|
| Hospital Charge Code |
915350101
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$892.00 |
| Max. Negotiated Rate |
$3,791.00 |
| Rate for Payer: Adventist Health Commercial |
$892.00
|
| Rate for Payer: Cash Price |
$2,007.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.00
|
| Rate for Payer: Galaxy Health WC |
$3,791.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,676.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,974.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,699.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,760.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.40
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: Networks By Design Commercial |
$2,899.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,791.00
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$566.10 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.40
|
| Rate for Payer: EPIC Health Plan Senior |
$266.40
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$412.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.84
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
|
|
HC HARVEST THAW WO WASHING
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 38208
|
| Hospital Charge Code |
900904699
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$133.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$436.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$445.55
|
| Rate for Payer: Blue Shield of California EPN |
$294.37
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna of CA HMO |
$426.24
|
| Rate for Payer: Cigna of CA PPO |
$492.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$611.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$555.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$749.90
|
| Rate for Payer: EPIC Health Plan Senior |
$555.48
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$910.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$555.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$699.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$744.34
|
| Rate for Payer: Multiplan Commercial |
$532.80
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.00
|
| Rate for Payer: United Healthcare All Other HMO |
$333.00
|
| Rate for Payer: United Healthcare HMO Rider |
$333.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$555.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$833.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$611.03
|
| Rate for Payer: Vantage Medical Group Senior |
$555.48
|
|
