|
HC TENOTOMY PERCUT TOE SNGL TENDN
|
Facility
OP
|
$8,359.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
900501072
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,671.80 |
| Max. Negotiated Rate |
$7,523.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,015.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,257.81
|
| Rate for Payer: Blue Shield of California EPN |
$4,087.55
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$3,761.55
|
| Rate for Payer: Cash Price |
$3,761.55
|
| Rate for Payer: Cash Price |
$3,761.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,687.20
|
| Rate for Payer: Cigna of CA HMO |
$5,349.76
|
| Rate for Payer: Cigna of CA PPO |
$6,185.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$7,105.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,015.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,523.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,269.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: IEHP medi-cal |
$3,313.35
|
| Rate for Payer: IEHP Medicare Advantage |
$2,008.09
|
| Rate for Payer: Innovage PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,575.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,671.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$6,269.25
|
| Rate for Payer: Networks By Design Commercial |
$5,433.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,105.15
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,015.40
|
| Rate for Payer: Riverside University Health MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,015.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,015.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,179.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,179.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC TENSION BASED SCOLIOSIS & PADS
|
Facility
OP
|
$3,513.00
|
|
|
Service Code
|
CPT L1005
|
| Hospital Charge Code |
905351005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,229.55 |
| Max. Negotiated Rate |
$12,695.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,695.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,986.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,932.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,932.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,700.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,075.48
|
| Rate for Payer: BCBS Transplant Transplant |
$2,107.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,634.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,911.07
|
| Rate for Payer: Cash Price |
$1,580.85
|
| Rate for Payer: Cash Price |
$1,580.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,810.40
|
| Rate for Payer: Cigna of CA HMO |
$2,459.10
|
| Rate for Payer: Cigna of CA PPO |
$2,459.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,986.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,405.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,405.20
|
| Rate for Payer: Galaxy Health WC |
$2,986.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,107.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,161.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,634.75
|
| Rate for Payer: IEHP medi-cal |
$1,229.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,343.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,440.33
|
| Rate for Payer: Multiplan Commercial |
$2,634.75
|
| Rate for Payer: Networks By Design Commercial |
$1,756.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,986.05
|
| Rate for Payer: Riverside University Health MISP |
$1,405.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,107.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,107.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,756.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,756.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,756.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,756.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,986.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,986.05
|
|
|
HC TENSION BASED SCOLIOSIS & PADS
|
Facility
IP
|
$3,513.00
|
|
|
Service Code
|
CPT L1005
|
| Hospital Charge Code |
905351005
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$702.60 |
| Max. Negotiated Rate |
$3,161.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,875.94
|
| Rate for Payer: Cash Price |
$1,580.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,810.40
|
| Rate for Payer: Cigna of CA HMO |
$2,459.10
|
| Rate for Payer: Cigna of CA PPO |
$2,459.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,405.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,405.20
|
| Rate for Payer: Galaxy Health WC |
$2,986.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,107.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,161.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,343.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.60
|
| Rate for Payer: Multiplan Commercial |
$2,634.75
|
| Rate for Payer: Networks By Design Commercial |
$1,756.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,986.05
|
|
|
HC TERM DEV MECH HAND VOL CLOSE
|
Facility
OP
|
$2,705.00
|
|
|
Service Code
|
CPT L6709
|
| Hospital Charge Code |
905356709
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$946.75 |
| Max. Negotiated Rate |
$5,358.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,358.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,299.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,487.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,487.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,309.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,598.11
|
| Rate for Payer: BCBS Transplant Transplant |
$1,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,028.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,471.52
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,893.50
|
| Rate for Payer: Cigna of CA PPO |
$1,893.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,299.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,028.75
|
| Rate for Payer: IEHP medi-cal |
$946.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,109.05
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,352.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
| Rate for Payer: Riverside University Health MISP |
$1,082.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,623.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,623.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,352.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,352.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,352.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,299.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,299.25
|
|
|
HC TERM DEV MECH HAND VOL CLOSE
|
Facility
IP
|
$2,705.00
|
|
|
Service Code
|
CPT L6709
|
| Hospital Charge Code |
905356709
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$2,434.50 |
| Rate for Payer: Blue Shield of California EPN |
$1,444.47
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,893.50
|
| Rate for Payer: Cigna of CA PPO |
$1,893.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,352.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
|
|
HC TERM DEV MECH HAND VOL OPEN
|
Facility
OP
|
$1,865.00
|
|
|
Service Code
|
CPT L6708
|
| Hospital Charge Code |
905356708
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$652.75 |
| Max. Negotiated Rate |
$3,699.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,699.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,585.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,025.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,025.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$903.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,101.84
|
| Rate for Payer: BCBS Transplant Transplant |
$1,119.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,398.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,014.56
|
| Rate for Payer: Cash Price |
$839.25
|
| Rate for Payer: Cash Price |
$839.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,492.00
|
| Rate for Payer: Cigna of CA HMO |
$1,305.50
|
| Rate for Payer: Cigna of CA PPO |
$1,305.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,585.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$746.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$746.00
|
| Rate for Payer: Galaxy Health WC |
$1,585.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,119.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,678.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,398.75
|
| Rate for Payer: IEHP medi-cal |
$652.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,243.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$764.65
|
| Rate for Payer: Multiplan Commercial |
$1,398.75
|
| Rate for Payer: Networks By Design Commercial |
$932.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,585.25
|
| Rate for Payer: Riverside University Health MISP |
$746.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,119.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,119.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$932.50
|
| Rate for Payer: United Healthcare All Other HMO |
$932.50
|
| Rate for Payer: United Healthcare HMO Rider |
$932.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$932.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,585.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,585.25
|
|
|
HC TERM DEV MECH HAND VOL OPEN
|
Facility
IP
|
$1,865.00
|
|
|
Service Code
|
CPT L6708
|
| Hospital Charge Code |
905356708
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.00 |
| Max. Negotiated Rate |
$1,678.50 |
| Rate for Payer: Blue Shield of California EPN |
$995.91
|
| Rate for Payer: Cash Price |
$839.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,492.00
|
| Rate for Payer: Cigna of CA HMO |
$1,305.50
|
| Rate for Payer: Cigna of CA PPO |
$1,305.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$746.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$746.00
|
| Rate for Payer: Galaxy Health WC |
$1,585.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,119.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,678.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,243.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.00
|
| Rate for Payer: Multiplan Commercial |
$1,398.75
|
| Rate for Payer: Networks By Design Commercial |
$932.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,585.25
|
|
|
HC TERM DEV MECH HOOK VOL CLOSE
|
Facility
IP
|
$2,760.00
|
|
|
Service Code
|
CPT L6707
|
| Hospital Charge Code |
905356707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$2,484.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,473.84
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.00
|
| Rate for Payer: Cigna of CA HMO |
$1,932.00
|
| Rate for Payer: Cigna of CA PPO |
$1,932.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,104.00
|
| Rate for Payer: Galaxy Health WC |
$2,346.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,840.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$2,070.00
|
| Rate for Payer: Networks By Design Commercial |
$1,380.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.00
|
|
|
HC TERM DEV MECH HOOK VOL CLOSE
|
Facility
OP
|
$2,760.00
|
|
|
Service Code
|
CPT L6707
|
| Hospital Charge Code |
905356707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$966.00 |
| Max. Negotiated Rate |
$5,688.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,688.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,346.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,518.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,518.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,336.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,630.61
|
| Rate for Payer: BCBS Transplant Transplant |
$1,656.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,070.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,501.44
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Cash Price |
$1,242.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.00
|
| Rate for Payer: Cigna of CA HMO |
$1,932.00
|
| Rate for Payer: Cigna of CA PPO |
$1,932.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,346.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,104.00
|
| Rate for Payer: Galaxy Health WC |
$2,346.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,070.00
|
| Rate for Payer: IEHP medi-cal |
$966.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,840.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.60
|
| Rate for Payer: Multiplan Commercial |
$2,070.00
|
| Rate for Payer: Networks By Design Commercial |
$1,380.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.00
|
| Rate for Payer: Riverside University Health MISP |
$1,104.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,656.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,656.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,380.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,380.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,346.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,346.00
|
|
|
HC TERM DEV MECH HOOK VOL OPEN
|
Facility
IP
|
$725.00
|
|
|
Service Code
|
CPT L6706
|
| Hospital Charge Code |
905356706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$652.50 |
| Rate for Payer: Blue Shield of California EPN |
$387.15
|
| Rate for Payer: Cash Price |
$326.25
|
| Rate for Payer: Central Health Plan Commercial |
$580.00
|
| Rate for Payer: Cigna of CA HMO |
$507.50
|
| Rate for Payer: Cigna of CA PPO |
$507.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$290.00
|
| Rate for Payer: Galaxy Health WC |
$616.25
|
| Rate for Payer: Global Benefits Group Commercial |
$435.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$652.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$483.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$543.75
|
| Rate for Payer: Networks By Design Commercial |
$362.50
|
| Rate for Payer: Prime Health Services Commercial |
$616.25
|
|
|
HC TERM DEV MECH HOOK VOL OPEN
|
Facility
OP
|
$725.00
|
|
|
Service Code
|
CPT L6706
|
| Hospital Charge Code |
905356706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$253.75 |
| Max. Negotiated Rate |
$1,543.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,543.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$616.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$398.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$398.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$351.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$428.33
|
| Rate for Payer: BCBS Transplant Transplant |
$435.00
|
| Rate for Payer: Blue Shield of California Commercial |
$543.75
|
| Rate for Payer: Blue Shield of California EPN |
$394.40
|
| Rate for Payer: Cash Price |
$326.25
|
| Rate for Payer: Cash Price |
$326.25
|
| Rate for Payer: Central Health Plan Commercial |
$580.00
|
| Rate for Payer: Cigna of CA HMO |
$507.50
|
| Rate for Payer: Cigna of CA PPO |
$507.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$616.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$290.00
|
| Rate for Payer: Galaxy Health WC |
$616.25
|
| Rate for Payer: Global Benefits Group Commercial |
$435.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$652.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$543.75
|
| Rate for Payer: IEHP medi-cal |
$253.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$483.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.25
|
| Rate for Payer: Multiplan Commercial |
$543.75
|
| Rate for Payer: Networks By Design Commercial |
$362.50
|
| Rate for Payer: Prime Health Services Commercial |
$616.25
|
| Rate for Payer: Riverside University Health MISP |
$290.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$435.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$362.50
|
| Rate for Payer: United Healthcare All Other HMO |
$362.50
|
| Rate for Payer: United Healthcare HMO Rider |
$362.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$362.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$616.25
|
| Rate for Payer: Vantage Medical Group Senior |
$616.25
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
OP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
905356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$1,437.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,437.84
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$332.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$292.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.43
|
| Rate for Payer: BCBS Transplant Transplant |
$363.00
|
| Rate for Payer: Blue Shield of California Commercial |
$453.75
|
| Rate for Payer: Blue Shield of California EPN |
$329.12
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$453.75
|
| Rate for Payer: IEHP medi-cal |
$211.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.05
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Riverside University Health MISP |
$242.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.50
|
| Rate for Payer: United Healthcare All Other HMO |
$302.50
|
| Rate for Payer: United Healthcare HMO Rider |
$302.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$302.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
IP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
905356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Blue Shield of California EPN |
$323.07
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
IP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
905356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Blue Shield of California EPN |
$699.54
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
OP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
905356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$458.50 |
| Max. Negotiated Rate |
$2,590.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,590.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$720.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$634.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$773.95
|
| Rate for Payer: BCBS Transplant Transplant |
$786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$982.50
|
| Rate for Payer: Blue Shield of California EPN |
$712.64
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$982.50
|
| Rate for Payer: IEHP medi-cal |
$458.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.10
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Riverside University Health MISP |
$524.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$655.00
|
| Rate for Payer: United Healthcare All Other HMO |
$655.00
|
| Rate for Payer: United Healthcare HMO Rider |
$655.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$655.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC TESTICULAR SCAN
|
Facility
OP
|
$1,309.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$992.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$661.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$773.36
|
| Rate for Payer: BCBS Transplant Transplant |
$785.40
|
| Rate for Payer: Blue Shield of California Commercial |
$808.96
|
| Rate for Payer: Blue Shield of California EPN |
$636.17
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,047.20
|
| Rate for Payer: Cigna of CA HMO |
$837.76
|
| Rate for Payer: Cigna of CA PPO |
$968.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,112.65
|
| Rate for Payer: Global Benefits Group Commercial |
$785.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,178.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$981.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: IEHP medi-cal |
$850.28
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Innovage PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
| Rate for Payer: Networks By Design Commercial |
$850.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,112.65
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$785.40
|
| Rate for Payer: Riverside University Health MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$785.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$785.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC TESTICULAR SCAN
|
Facility
IP
|
$1,309.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$261.80 |
| Max. Negotiated Rate |
$1,178.10 |
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,047.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.60
|
| Rate for Payer: Galaxy Health WC |
$1,112.65
|
| Rate for Payer: Global Benefits Group Commercial |
$785.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,178.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.80
|
| Rate for Payer: Multiplan Commercial |
$981.75
|
| Rate for Payer: Networks By Design Commercial |
$850.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,112.65
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
IP
|
$308.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$277.20 |
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$246.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$123.20
|
| Rate for Payer: Galaxy Health WC |
$261.80
|
| Rate for Payer: Global Benefits Group Commercial |
$184.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$277.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$205.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$231.00
|
| Rate for Payer: Networks By Design Commercial |
$200.20
|
| Rate for Payer: Prime Health Services Commercial |
$261.80
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
OP
|
$50.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$229.04 |
| Rate for Payer: Adventist Health Medi-Cal |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.04
|
| Rate for Payer: BCBS Transplant Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$25.81
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$25.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.33
|
| Rate for Payer: IEHP medi-cal |
$42.59
|
| Rate for Payer: IEHP Medicare Advantage |
$25.81
|
| Rate for Payer: Innovage PACE Commercial |
$38.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$27.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: Riverside University Health MISP |
$28.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC TEST PHYSICAL PERF ADDL 15MIN OT
|
Facility
OP
|
$170.00
|
|
|
Service Code
|
CPT 97691
|
| Hospital Charge Code |
903207691
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$103.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$102.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$127.50
|
| Rate for Payer: IEHP medi-cal |
$59.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: Riverside University Health MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC TEST PHYSICAL PERF ADDL 15MIN OT
|
Facility
IP
|
$170.00
|
|
|
Service Code
|
CPT 97691
|
| Hospital Charge Code |
903207691
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC TEST PHYSICAL PERF ADDL 15MIN PT
|
Facility
IP
|
$170.00
|
|
|
Service Code
|
CPT 97691
|
| Hospital Charge Code |
903200168
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$34.00 |
| Max. Negotiated Rate |
$153.00 |
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.00
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC TEST PHYSICAL PERF ADDL 15MIN PT
|
Facility
OP
|
$170.00
|
|
|
Service Code
|
CPT 97691
|
| Hospital Charge Code |
903200168
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.50 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$103.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$144.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$102.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Central Health Plan Commercial |
$136.00
|
| Rate for Payer: Cigna of CA HMO |
$108.80
|
| Rate for Payer: Cigna of CA PPO |
$125.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$127.50
|
| Rate for Payer: IEHP medi-cal |
$59.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.70
|
| Rate for Payer: Multiplan Commercial |
$127.50
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: Riverside University Health MISP |
$68.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.50
|
| Rate for Payer: Vantage Medical Group Senior |
$144.50
|
|
|
HC TEST PHYSICAL PERF INITIAL 30MIN OT
|
Facility
IP
|
$158.00
|
|
|
Service Code
|
CPT 97690
|
| Hospital Charge Code |
903207690
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$142.20 |
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
|
|
HC TEST PHYSICAL PERF INITIAL 30MIN OT
|
Facility
OP
|
$158.00
|
|
|
Service Code
|
CPT 97690
|
| Hospital Charge Code |
903207690
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$55.30 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$95.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$134.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$86.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$86.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$94.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$134.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$63.20
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$118.50
|
| Rate for Payer: IEHP medi-cal |
$55.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.78
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: Riverside University Health MISP |
$63.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$134.30
|
| Rate for Payer: Vantage Medical Group Senior |
$134.30
|
|
