|
HC TLSO TRIPLANAR CONTROL ONE PIECE
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT L0488
|
| Hospital Charge Code |
915350488
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$794.19 |
| Max. Negotiated Rate |
$2,182.50 |
| Rate for Payer: Adventist Health Commercial |
$994.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,333.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,818.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,410.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,944.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,222.20
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Cash Price |
$1,091.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,940.00
|
| Rate for Payer: Cigna of CA HMO |
$1,697.50
|
| Rate for Payer: Cigna of CA PPO |
$1,697.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,061.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,061.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,697.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$970.00
|
| Rate for Payer: EPIC Health Plan Senior |
$970.00
|
| Rate for Payer: Galaxy Health WC |
$2,061.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,455.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,182.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,085.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,539.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,198.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,430.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$994.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,697.50
|
| Rate for Payer: Multiplan Commercial |
$1,818.75
|
| Rate for Payer: Networks By Design Commercial |
$1,212.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,061.25
|
| Rate for Payer: Riverside University Health System MISP |
$970.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,455.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,455.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.10
|
| Rate for Payer: United Healthcare All Other HMO |
$885.85
|
| Rate for Payer: United Healthcare HMO Rider |
$866.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$794.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,061.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,061.25
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$274.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: Cigna of CA HMO |
$234.24
|
| Rate for Payer: Cigna of CA PPO |
$270.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.40
|
| Rate for Payer: EPIC Health Plan Senior |
$146.40
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$329.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$235.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$232.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$260.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$256.20
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
| Rate for Payer: Riverside University Health System MISP |
$146.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$183.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.10
|
| Rate for Payer: Vantage Medical Group Senior |
$311.10
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$73.20 |
| Max. Negotiated Rate |
$329.40 |
| Rate for Payer: Adventist Health Commercial |
$73.20
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Central Health Plan Commercial |
$292.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$256.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.40
|
| Rate for Payer: EPIC Health Plan Senior |
$146.40
|
| Rate for Payer: Galaxy Health WC |
$311.10
|
| Rate for Payer: Global Benefits Group Commercial |
$219.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$329.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$232.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.20
|
| Rate for Payer: Multiplan Commercial |
$274.50
|
| Rate for Payer: Networks By Design Commercial |
$237.90
|
| Rate for Payer: Prime Health Services Commercial |
$311.10
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
OP
|
$959.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.05 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.65
|
| 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 Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Blue Shield of California Commercial |
$604.17
|
| Rate for Payer: Blue Shield of California EPN |
$380.72
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Cigna of CA HMO |
$613.76
|
| Rate for Payer: Cigna of CA PPO |
$709.66
|
| 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 |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$575.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$575.40
|
| 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 TMJ OPEN CLOSE UNILATERAL
|
Facility
|
IP
|
$959.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.80 |
| Max. Negotiated Rate |
$863.10 |
| Rate for Payer: Adventist Health Commercial |
$191.80
|
| Rate for Payer: Cash Price |
$431.55
|
| Rate for Payer: Central Health Plan Commercial |
$767.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$671.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.60
|
| Rate for Payer: EPIC Health Plan Senior |
$383.60
|
| Rate for Payer: Galaxy Health WC |
$815.15
|
| Rate for Payer: Global Benefits Group Commercial |
$575.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$863.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$608.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$565.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.80
|
| Rate for Payer: Multiplan Commercial |
$719.25
|
| Rate for Payer: Networks By Design Commercial |
$623.35
|
| Rate for Payer: Prime Health Services Commercial |
$815.15
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
OP
|
$1,856.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.96 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Adventist Health Commercial |
$371.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$364.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$437.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$608.18
|
| Rate for Payer: Blue Shield of California Commercial |
$1,169.28
|
| Rate for Payer: Blue Shield of California EPN |
$736.83
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,484.80
|
| Rate for Payer: Cigna of CA HMO |
$1,187.84
|
| Rate for Payer: Cigna of CA PPO |
$1,373.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$1,577.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,113.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,670.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$116.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,178.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$129.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: Networks By Design Commercial |
$1,206.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$1,577.60
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,113.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,113.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
IP
|
$1,856.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.20 |
| Max. Negotiated Rate |
$1,670.40 |
| Rate for Payer: Adventist Health Commercial |
$371.20
|
| Rate for Payer: Cash Price |
$835.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,484.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$742.40
|
| Rate for Payer: EPIC Health Plan Senior |
$742.40
|
| Rate for Payer: Galaxy Health WC |
$1,577.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,113.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,670.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,178.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,095.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$371.20
|
| Rate for Payer: Multiplan Commercial |
$1,392.00
|
| Rate for Payer: Networks By Design Commercial |
$1,206.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,577.60
|
|
|
HC TOBRAMYCIN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC TOBRAMYCIN
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.13
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.01
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California Commercial |
$137.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Blue Shield of California EPN |
$86.55
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.61
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.13
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.13
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Medicare |
$17.10
|
| Rate for Payer: Prime Health Services Medicare |
$17.10
|
| Rate for Payer: Riverside University Health System MISP |
$17.74
|
| Rate for Payer: Riverside University Health System MISP |
$17.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO |
$13.07
|
| Rate for Payer: United Healthcare HMO Rider |
$13.07
|
| Rate for Payer: United Healthcare HMO Rider |
$13.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Vantage Medical Group Senior |
$16.13
|
| Rate for Payer: Vantage Medical Group Senior |
$16.13
|
|
|
HC TOES
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Central Health Plan Commercial |
$592.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$436.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
|
|
HC TOES
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.81 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.09
|
| 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 Exchange |
$87.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.09
|
| Rate for Payer: Blue Shield of California Commercial |
$466.20
|
| Rate for Payer: Blue Shield of California EPN |
$293.78
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Cash Price |
$333.00
|
| Rate for Payer: Central Health Plan Commercial |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$473.60
|
| Rate for Payer: Cigna of CA PPO |
$547.60
|
| 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 |
$518.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$469.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.00
|
| 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 |
$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 TOE TAP SHOE ADD
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
915353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.63
|
| Rate for Payer: Blue Shield of California Commercial |
$16.04
|
| Rate for Payer: Blue Shield of California EPN |
$10.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
905353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.63
|
| Rate for Payer: Blue Shield of California Commercial |
$16.04
|
| Rate for Payer: Blue Shield of California EPN |
$10.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
915353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.04
|
| Rate for Payer: Blue Shield of California EPN |
$10.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
905353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.04
|
| Rate for Payer: Blue Shield of California EPN |
$10.08
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
|
|
HC TOMO BILAT DIAG
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
900377062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$448.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.40
|
| Rate for Payer: EPIC Health Plan Senior |
$256.40
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
|
|
HC TOMO BILAT DIAG
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
900377062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$568.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$544.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$352.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$461.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.87
|
| Rate for Payer: Blue Shield of California Commercial |
$403.83
|
| Rate for Payer: Blue Shield of California EPN |
$254.48
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Cash Price |
$288.45
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: Cigna of CA HMO |
$410.24
|
| Rate for Payer: Cigna of CA PPO |
$474.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$544.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$544.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$544.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$448.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.40
|
| Rate for Payer: EPIC Health Plan Senior |
$256.40
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$407.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$378.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$448.70
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
| Rate for Payer: Riverside University Health System MISP |
$256.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.06
|
| Rate for Payer: United Healthcare All Other HMO |
$241.06
|
| Rate for Payer: United Healthcare HMO Rider |
$241.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$544.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$544.85
|
| Rate for Payer: Vantage Medical Group Senior |
$544.85
|
|
|
HC TOMO BILAT SCREENING
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
900377063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$221.87 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.48
|
| Rate for Payer: Blue Shield of California Commercial |
$73.08
|
| Rate for Payer: Blue Shield of California EPN |
$46.05
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$90.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Riverside University Health System MISP |
$46.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.60
|
| Rate for Payer: Vantage Medical Group Senior |
$98.60
|
|
|
HC TOMO BILAT SCREENING
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
900377063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
|
|
HC TOMOGRAPHY COMPLEX MOTION BODY SEC
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 76101
|
| Hospital Charge Code |
909001156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Adventist Health Commercial |
$132.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$561.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$363.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$296.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.67
|
| Rate for Payer: Blue Shield of California Commercial |
$416.43
|
| Rate for Payer: Blue Shield of California EPN |
$262.42
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Central Health Plan Commercial |
$528.80
|
| Rate for Payer: Cigna of CA HMO |
$423.04
|
| Rate for Payer: Cigna of CA PPO |
$489.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$561.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$561.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$462.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.40
|
| Rate for Payer: EPIC Health Plan Senior |
$264.40
|
| Rate for Payer: Galaxy Health WC |
$561.85
|
| Rate for Payer: Global Benefits Group Commercial |
$396.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$594.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$419.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$239.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$389.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$462.70
|
| Rate for Payer: Multiplan Commercial |
$495.75
|
| Rate for Payer: Networks By Design Commercial |
$429.65
|
| Rate for Payer: Prime Health Services Commercial |
$561.85
|
| Rate for Payer: Riverside University Health System MISP |
$264.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$396.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$396.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.50
|
| Rate for Payer: United Healthcare All Other HMO |
$330.50
|
| Rate for Payer: United Healthcare HMO Rider |
$330.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$561.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.85
|
| Rate for Payer: Vantage Medical Group Senior |
$561.85
|
|
|
HC TOMOGRAPHY COMPLEX MOTION BODY SEC
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT 76101
|
| Hospital Charge Code |
909001156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Adventist Health Commercial |
$132.20
|
| Rate for Payer: Cash Price |
$297.45
|
| Rate for Payer: Central Health Plan Commercial |
$528.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$462.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.40
|
| Rate for Payer: EPIC Health Plan Senior |
$264.40
|
| Rate for Payer: Galaxy Health WC |
$561.85
|
| Rate for Payer: Global Benefits Group Commercial |
$396.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$594.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$419.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$389.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.20
|
| Rate for Payer: Multiplan Commercial |
$495.75
|
| Rate for Payer: Networks By Design Commercial |
$429.65
|
| Rate for Payer: Prime Health Services Commercial |
$561.85
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$613.80 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Central Health Plan Commercial |
$545.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$477.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$613.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$402.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.40
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.23 |
| Max. Negotiated Rate |
$613.80 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$481.22
|
| 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 Exchange |
$261.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$363.87
|
| Rate for Payer: Blue Shield of California Commercial |
$429.66
|
| Rate for Payer: Blue Shield of California EPN |
$270.75
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Central Health Plan Commercial |
$545.60
|
| Rate for Payer: Cigna of CA HMO |
$436.48
|
| Rate for Payer: Cigna of CA PPO |
$504.68
|
| 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 |
$477.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$613.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$433.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| 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 TOMO GUIDED BREAST BX
|
Facility
|
OP
|
$13,306.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
906609499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,661.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,661.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5,035.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,035.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,442.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,740.10
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,987.70
|
| Rate for Payer: Cash Price |
$5,987.70
|
| Rate for Payer: Cash Price |
$5,987.70
|
| Rate for Payer: Central Health Plan Commercial |
$10,644.80
|
| Rate for Payer: Cigna of CA HMO |
$8,515.84
|
| Rate for Payer: Cigna of CA PPO |
$9,846.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,539.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,035.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,314.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,309.24
|
| Rate for Payer: EPIC Health Plan Senior |
$5,539.49
|
| Rate for Payer: Galaxy Health WC |
$11,310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,983.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,975.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,258.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,449.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,050.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,661.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,748.11
|
| Rate for Payer: Multiplan Commercial |
$9,979.50
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$8,648.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5,035.90
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$11,310.10
|
| Rate for Payer: Prime Health Services Medicare |
$5,338.05
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,539.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,983.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,653.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5,035.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,553.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,539.49
|
| Rate for Payer: Vantage Medical Group Senior |
$5,035.90
|
|
|
HC TOMO GUIDED BREAST BX
|
Facility
|
IP
|
$13,306.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
906609499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,661.20 |
| Max. Negotiated Rate |
$11,975.40 |
| Rate for Payer: Adventist Health Commercial |
$2,661.20
|
| Rate for Payer: Cash Price |
$5,987.70
|
| Rate for Payer: Central Health Plan Commercial |
$10,644.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,314.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,322.40
|
| Rate for Payer: Galaxy Health WC |
$11,310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,983.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,975.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,449.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,850.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,661.20
|
| Rate for Payer: Multiplan Commercial |
$9,979.50
|
| Rate for Payer: Networks By Design Commercial |
$8,648.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,310.10
|
|
