|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
IP
|
$850.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$170.00 |
| Max. Negotiated Rate |
$722.50 |
| Rate for Payer: Adventist Health Commercial |
$170.00
|
| Rate for Payer: Cash Price |
$382.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.00
|
| Rate for Payer: EPIC Health Plan Senior |
$340.00
|
| Rate for Payer: Galaxy Health WC |
$722.50
|
| Rate for Payer: Global Benefits Group Commercial |
$510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$539.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$501.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.00
|
| Rate for Payer: Multiplan Commercial |
$680.00
|
| Rate for Payer: Networks By Design Commercial |
$552.50
|
| Rate for Payer: Prime Health Services Commercial |
$722.50
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$656.22 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$656.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$487.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$315.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.34
|
| Rate for Payer: Blue Shield of California Commercial |
$366.21
|
| Rate for Payer: Blue Shield of California Commercial |
$241.65
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna of CA HMO |
$367.36
|
| Rate for Payer: Cigna of CA PPO |
$424.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$487.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$487.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$487.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$401.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$229.60
|
| Rate for Payer: Galaxy Health WC |
$487.90
|
| Rate for Payer: Global Benefits Group Commercial |
$344.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$364.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$338.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$401.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$401.80
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: Networks By Design Commercial |
$373.10
|
| Rate for Payer: Prime Health Services Commercial |
$487.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$344.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.70
|
| Rate for Payer: United Healthcare All Other HMO |
$252.70
|
| Rate for Payer: United Healthcare HMO Rider |
$252.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$487.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$487.90
|
| Rate for Payer: Vantage Medical Group Senior |
$487.90
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$487.90 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$401.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$229.60
|
| Rate for Payer: Galaxy Health WC |
$487.90
|
| Rate for Payer: Global Benefits Group Commercial |
$344.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$364.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$338.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.76
|
| Rate for Payer: Multiplan Commercial |
$459.20
|
| Rate for Payer: Networks By Design Commercial |
$373.10
|
| Rate for Payer: Prime Health Services Commercial |
$487.90
|
|
|
HC MAMMOTOME PROBE 8 GA
|
Facility
|
OP
|
$792.00
|
|
| Hospital Charge Code |
906601883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$519.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$594.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$508.23
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$673.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$554.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$554.40
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$396.00
|
| Rate for Payer: United Healthcare HMO Rider |
$396.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
|
HC MAMMOTOME PROBE 8 GA
|
Facility
|
IP
|
$792.00
|
|
| Hospital Charge Code |
906601883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$673.20 |
| Rate for Payer: Adventist Health Commercial |
$158.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$554.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Senior |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$502.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$467.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.08
|
| Rate for Payer: Multiplan Commercial |
$633.60
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
OP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$708.05 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$546.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$534.54
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Cigna of CA HMO |
$533.12
|
| Rate for Payer: Cigna of CA PPO |
$616.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$302.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$583.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$583.10
|
| Rate for Payer: Multiplan Commercial |
$666.40
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other HMO |
$416.50
|
| Rate for Payer: United Healthcare HMO Rider |
$416.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$416.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
IP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$708.05 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.92
|
| Rate for Payer: Multiplan Commercial |
$666.40
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
IP
|
$1,260.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.00 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.00
|
| Rate for Payer: EPIC Health Plan Senior |
$504.00
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$743.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
OP
|
$1,260.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.19 |
| Max. Negotiated Rate |
$1,071.00 |
| Rate for Payer: Adventist Health Commercial |
$252.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$197.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.59
|
| Rate for Payer: Blue Shield of California Commercial |
$530.46
|
| Rate for Payer: Blue Shield of California Commercial |
$803.88
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cash Price |
$567.00
|
| Rate for Payer: Cigna of CA HMO |
$806.40
|
| Rate for Payer: Cigna of CA PPO |
$932.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,071.00
|
| Rate for Payer: Global Benefits Group Commercial |
$756.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,008.00
|
| Rate for Payer: Networks By Design Commercial |
$819.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$756.00
|
| 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: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC MANDIBLE LIMITED
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
909001123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.17 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$172.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.06
|
| Rate for Payer: Blue Shield of California Commercial |
$340.59
|
| Rate for Payer: Blue Shield of California Commercial |
$516.14
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$42.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$485.40
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MANDIBLE LIMITED
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
909001123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC MANDIBLE-PANOREX
|
Facility
|
OP
|
$748.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
909001124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$635.80 |
| Rate for Payer: Adventist Health Commercial |
$149.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.37
|
| Rate for Payer: Blue Shield of California Commercial |
$314.91
|
| Rate for Payer: Blue Shield of California Commercial |
$477.22
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Cigna of CA HMO |
$478.72
|
| Rate for Payer: Cigna of CA PPO |
$553.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$523.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$635.80
|
| Rate for Payer: Global Benefits Group Commercial |
$448.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$474.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: Networks By Design Commercial |
$486.20
|
| Rate for Payer: Prime Health Services Commercial |
$635.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$448.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$448.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.10
|
| Rate for Payer: United Healthcare All Other HMO |
$82.10
|
| Rate for Payer: United Healthcare HMO Rider |
$82.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MANDIBLE-PANOREX
|
Facility
|
IP
|
$748.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
909001124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$635.80 |
| Rate for Payer: Adventist Health Commercial |
$149.60
|
| Rate for Payer: Cash Price |
$336.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$523.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Senior |
$299.20
|
| Rate for Payer: Galaxy Health WC |
$635.80
|
| Rate for Payer: Global Benefits Group Commercial |
$448.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$474.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$441.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.52
|
| Rate for Payer: Multiplan Commercial |
$598.40
|
| Rate for Payer: Networks By Design Commercial |
$486.20
|
| Rate for Payer: Prime Health Services Commercial |
$635.80
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900400053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900400053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$137.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
IP
|
$336.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
901300057
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$285.60 |
| Rate for Payer: Adventist Health Commercial |
$67.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
OP
|
$336.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
901300057
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$37.31 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$137.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$184.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cash Price |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$215.04
|
| Rate for Payer: Cigna of CA PPO |
$248.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$285.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$285.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$235.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.40
|
| Rate for Payer: EPIC Health Plan Senior |
$134.40
|
| Rate for Payer: Galaxy Health WC |
$285.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$213.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$268.80
|
| Rate for Payer: Networks By Design Commercial |
$218.40
|
| Rate for Payer: Prime Health Services Commercial |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 |
$285.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$285.60
|
| Rate for Payer: Vantage Medical Group Senior |
$285.60
|
|
|
HC MARATHON LIQUID SKIN PROTECTANT
|
Facility
|
IP
|
$43.38
|
|
| Hospital Charge Code |
901607240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$36.87 |
| Rate for Payer: Adventist Health Commercial |
$8.68
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.35
|
| Rate for Payer: EPIC Health Plan Senior |
$17.35
|
| Rate for Payer: Galaxy Health WC |
$36.87
|
| Rate for Payer: Global Benefits Group Commercial |
$26.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$34.70
|
| Rate for Payer: Networks By Design Commercial |
$28.20
|
| Rate for Payer: Prime Health Services Commercial |
$36.87
|
|
|
HC MARATHON LIQUID SKIN PROTECTANT
|
Facility
|
OP
|
$43.38
|
|
| Hospital Charge Code |
901607240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$36.87 |
| Rate for Payer: Adventist Health Commercial |
$8.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.84
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Cigna of CA HMO |
$27.76
|
| Rate for Payer: Cigna of CA PPO |
$32.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.35
|
| Rate for Payer: EPIC Health Plan Senior |
$17.35
|
| Rate for Payer: Galaxy Health WC |
$36.87
|
| Rate for Payer: Global Benefits Group Commercial |
$26.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.37
|
| Rate for Payer: Multiplan Commercial |
$34.70
|
| Rate for Payer: Networks By Design Commercial |
$28.20
|
| Rate for Payer: Prime Health Services Commercial |
$36.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.87
|
| Rate for Payer: Vantage Medical Group Senior |
$36.87
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
905353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
915353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.63
|
| Rate for Payer: Blue Shield of California Commercial |
$63.06
|
| Rate for Payer: Blue Shield of California Commercial |
$41.57
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
905353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.63
|
| Rate for Payer: Blue Shield of California Commercial |
$63.06
|
| Rate for Payer: Blue Shield of California Commercial |
$41.57
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
915353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
HC MARSUPIALIZATION OF BARTHOLINS GLAND CYST
|
Facility
|
OP
|
$6,159.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
900556440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.09 |
| Max. Negotiated Rate |
$6,869.74 |
| Rate for Payer: Adventist Health Commercial |
$1,231.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Cigna of CA HMO |
$3,941.76
|
| Rate for Payer: Cigna of CA PPO |
$4,557.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,311.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$5,235.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,695.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,910.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$385.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,478.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,245.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$4,927.20
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,003.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,235.15
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,695.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,079.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,079.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,079.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,079.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC MARSUPIALIZATION OF BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$6,159.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
900556440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,231.80 |
| Max. Negotiated Rate |
$5,235.15 |
| Rate for Payer: Adventist Health Commercial |
$1,231.80
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,311.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,463.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,463.60
|
| Rate for Payer: Galaxy Health WC |
$5,235.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,695.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,910.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,633.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,478.16
|
| Rate for Payer: Multiplan Commercial |
$4,927.20
|
| Rate for Payer: Networks By Design Commercial |
$4,003.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,235.15
|
|
