|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.80
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$224.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.90
|
| Rate for Payer: Dignity Health Media |
$317.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$280.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.80
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Riverside University Health System MISP |
$149.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.90
|
| Rate for Payer: Vantage Medical Group Senior |
$317.90
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
IP
|
$864.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.80 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.60
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$329.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.46 |
| Max. Negotiated Rate |
$777.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$123.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Distinction Transplant |
$518.40
|
| Rate for Payer: Blue Shield of California Commercial |
$533.95
|
| Rate for Payer: Blue Shield of California EPN |
$419.90
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Central Health Plan Commercial |
$691.20
|
| Rate for Payer: Cigna of CA HMO |
$552.96
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$777.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$648.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$576.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$172.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$518.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
IP
|
$1,672.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$334.40 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,337.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$668.80
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,504.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$637.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.40
|
| Rate for Payer: Multiplan Commercial |
$1,254.00
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
OP
|
$1,672.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$1,504.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$437.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$533.60
|
| Rate for Payer: Blue Distinction Transplant |
$1,003.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,033.30
|
| Rate for Payer: Blue Shield of California EPN |
$812.59
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Cash Price |
$752.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,337.60
|
| Rate for Payer: Cigna of CA HMO |
$1,070.08
|
| Rate for Payer: Cigna of CA PPO |
$1,237.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,421.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,003.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,504.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,254.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$334.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,254.00
|
| Rate for Payer: Networks By Design Commercial |
$1,086.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,421.20
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,003.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,003.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC TOBRAMYCIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$143.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.13
|
| 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 Medi-Cal |
$17.74
|
| 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 HMO/PPO |
$143.02
|
| Rate for Payer: Blue Distinction 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 |
$16.13
|
| 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 |
$24.20
|
| Rate for Payer: Dignity Health Media |
$16.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.13
|
| 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) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: InnovAge PACE Commercial |
$24.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.61
|
| 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 |
$17.10
|
| Rate for Payer: Riverside University Health System MISP |
$17.74
|
| 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 |
$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 Select/Navigate/Core |
$13.07
|
| 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 Senior |
$16.13
|
|
|
HC TOBRAMYCIN
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$200.70 |
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
|
|
HC TOES
|
Facility
|
OP
|
$666.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.62 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.11
|
| Rate for Payer: Blue Distinction Transplant |
$399.60
|
| Rate for Payer: Blue Shield of California Commercial |
$411.59
|
| Rate for Payer: Blue Shield of California EPN |
$323.68
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Central Health Plan Commercial |
$532.80
|
| Rate for Payer: Cigna of CA HMO |
$426.24
|
| Rate for Payer: Cigna of CA PPO |
$492.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$599.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$499.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$399.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC TOES
|
Facility
|
IP
|
$666.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.20 |
| Max. Negotiated Rate |
$599.40 |
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Central Health Plan Commercial |
$532.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.40
|
| Rate for Payer: Galaxy Health WC |
$566.10
|
| Rate for Payer: Global Benefits Group Commercial |
$399.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$599.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.20
|
| Rate for Payer: Multiplan Commercial |
$499.50
|
| Rate for Payer: Networks By Design Commercial |
$432.90
|
| Rate for Payer: Prime Health Services Commercial |
$566.10
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
905353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$18.00 |
| 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 |
$11.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.82
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.00
|
| Rate for Payer: Blue Shield of California EPN |
$10.88
|
| 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 Media |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| 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 |
$10.00
|
| Rate for Payer: United Healthcare All Other HMO |
$10.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.00
|
| 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 |
905353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Blue Shield of California EPN |
$10.68
|
| 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: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| 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 |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.55
|
| Rate for Payer: United Healthcare All Other HMO |
$7.38
|
| Rate for Payer: United Healthcare HMO Rider |
$7.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
|
|
HC TOMO BILAT DIAG
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
900377062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$477.00 |
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Central Health Plan Commercial |
$424.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.00
|
| Rate for Payer: Galaxy Health WC |
$450.50
|
| Rate for Payer: Global Benefits Group Commercial |
$318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.00
|
| Rate for Payer: Multiplan Commercial |
$397.50
|
| Rate for Payer: Networks By Design Commercial |
$344.50
|
| Rate for Payer: Prime Health Services Commercial |
$450.50
|
|
|
HC TOMO BILAT DIAG
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
900377062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$530.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$530.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$450.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$291.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$291.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$461.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$313.12
|
| Rate for Payer: Blue Distinction Transplant |
$318.00
|
| Rate for Payer: Blue Shield of California Commercial |
$327.54
|
| Rate for Payer: Blue Shield of California EPN |
$257.58
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Central Health Plan Commercial |
$424.00
|
| Rate for Payer: Cigna of CA HMO |
$339.20
|
| Rate for Payer: Cigna of CA PPO |
$392.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$450.50
|
| Rate for Payer: Dignity Health Media |
$450.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$450.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$212.00
|
| Rate for Payer: Galaxy Health WC |
$450.50
|
| Rate for Payer: Global Benefits Group Commercial |
$318.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$477.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$397.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$185.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$353.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.00
|
| Rate for Payer: Multiplan Commercial |
$397.50
|
| Rate for Payer: Networks By Design Commercial |
$344.50
|
| Rate for Payer: Prime Health Services Commercial |
$450.50
|
| Rate for Payer: Riverside University Health System MISP |
$212.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$318.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$318.00
|
| 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 Medi-Cal |
$450.50
|
| Rate for Payer: Vantage Medical Group Senior |
$450.50
|
|
|
HC TOMO BILAT SCREENING
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
900377063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC TOMO BILAT SCREENING
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
900377063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$221.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$144.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.99
|
| Rate for Payer: Blue Distinction Transplant |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$54.38
|
| Rate for Payer: Blue Shield of California EPN |
$42.77
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Media |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$66.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Riverside University Health System MISP |
$35.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| 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 Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
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: Cash Price |
$306.90
|
| Rate for Payer: Central Health Plan Commercial |
$545.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| 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 |
$108.51 |
| Max. Negotiated Rate |
$613.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$425.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$319.25
|
| Rate for Payer: Blue Distinction Transplant |
$409.20
|
| Rate for Payer: Blue Shield of California Commercial |
$421.48
|
| Rate for Payer: Blue Shield of California EPN |
$331.45
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| 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 |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| 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: Health Plan of Nevada (Sierra) Other |
$511.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| 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: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC TOMO GUIDED BREAST BX
|
Facility
|
OP
|
$10,061.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
906609499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,012.20 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,762.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,762.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,871.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,944.04
|
| Rate for Payer: Blue Distinction Transplant |
$6,036.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$4,762.51
|
| Rate for Payer: Cash Price |
$4,527.45
|
| Rate for Payer: Cash Price |
$4,527.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,048.80
|
| Rate for Payer: Cigna of CA PPO |
$7,445.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Dignity Health Media |
$4,762.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,238.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,429.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,762.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,762.51
|
| Rate for Payer: Galaxy Health WC |
$8,551.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,036.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,054.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,545.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,810.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7,858.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,762.51
|
| Rate for Payer: InnovAge PACE Commercial |
$7,143.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,710.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,762.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,012.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,381.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,381.76
|
| Rate for Payer: Multiplan Commercial |
$7,545.75
|
| Rate for Payer: Networks By Design Commercial |
$6,539.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,551.85
|
| Rate for Payer: Prime Health Services Medicare |
$5,048.26
|
| Rate for Payer: Riverside University Health System MISP |
$5,238.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,036.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,143.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,238.76
|
| Rate for Payer: Vantage Medical Group Senior |
$4,762.51
|
|
|
HC TOMO GUIDED BREAST BX
|
Facility
|
IP
|
$10,061.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
906609499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,012.20 |
| Max. Negotiated Rate |
$9,054.90 |
| Rate for Payer: Cash Price |
$4,527.45
|
| Rate for Payer: Central Health Plan Commercial |
$8,048.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,024.40
|
| Rate for Payer: Galaxy Health WC |
$8,551.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,036.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,054.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,710.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,833.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,012.20
|
| Rate for Payer: Multiplan Commercial |
$7,545.75
|
| Rate for Payer: Networks By Design Commercial |
$6,539.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,551.85
|
|
|
HC TOMO UNILAT
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
900377061
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$675.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$675.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$194.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$208.55
|
| Rate for Payer: Blue Distinction Transplant |
$211.80
|
| Rate for Payer: Blue Shield of California Commercial |
$218.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.56
|
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Central Health Plan Commercial |
$282.40
|
| Rate for Payer: Cigna of CA HMO |
$225.92
|
| Rate for Payer: Cigna of CA PPO |
$261.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.05
|
| Rate for Payer: Dignity Health Media |
$300.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$141.20
|
| Rate for Payer: Galaxy Health WC |
$300.05
|
| Rate for Payer: Global Benefits Group Commercial |
$211.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$317.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$264.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.60
|
| Rate for Payer: Multiplan Commercial |
$264.75
|
| Rate for Payer: Networks By Design Commercial |
$229.45
|
| Rate for Payer: Prime Health Services Commercial |
$300.05
|
| Rate for Payer: Riverside University Health System MISP |
$141.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$211.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$211.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$307.94
|
| Rate for Payer: United Healthcare All Other HMO |
$307.94
|
| Rate for Payer: United Healthcare HMO Rider |
$307.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$307.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.05
|
| Rate for Payer: Vantage Medical Group Senior |
$300.05
|
|
|
HC TOMO UNILAT
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
900377061
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$70.60 |
| Max. Negotiated Rate |
$317.70 |
| Rate for Payer: Cash Price |
$158.85
|
| Rate for Payer: Central Health Plan Commercial |
$282.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$141.20
|
| Rate for Payer: Galaxy Health WC |
$300.05
|
| Rate for Payer: Global Benefits Group Commercial |
$211.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$317.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$235.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$134.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.60
|
| Rate for Payer: Multiplan Commercial |
$264.75
|
| Rate for Payer: Networks By Design Commercial |
$229.45
|
| Rate for Payer: Prime Health Services Commercial |
$300.05
|
|
|
HC TORSION CONTROL ANKLE JOINT ADDITION LE
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L2375
|
| Hospital Charge Code |
905352375
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.05 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$117.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.56
|
| Rate for Payer: Blue Distinction Transplant |
$145.80
|
| Rate for Payer: Blue Shield of California Commercial |
$182.25
|
| Rate for Payer: Blue Shield of California EPN |
$132.19
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Media |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$182.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$85.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.63
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Riverside University Health System MISP |
$97.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.50
|
| Rate for Payer: United Healthcare All Other HMO |
$121.50
|
| Rate for Payer: United Healthcare HMO Rider |
$121.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC TORSION CONTROL ANKLE JOINT ADDITION LE
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L2375
|
| Hospital Charge Code |
905352375
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Blue Shield of California EPN |
$129.76
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$121.50
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.76
|
| Rate for Payer: United Healthcare All Other HMO |
$89.62
|
| Rate for Payer: United Healthcare HMO Rider |
$87.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$80.19
|
|
|
HC TORSION CONTROL KNEE JOINT ADDITION LE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L2380
|
| Hospital Charge Code |
905352380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Blue Shield of California EPN |
$106.80
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Cigna of CA HMO |
$140.00
|
| Rate for Payer: Cigna of CA PPO |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$100.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.52
|
| Rate for Payer: United Healthcare All Other HMO |
$73.76
|
| Rate for Payer: United Healthcare HMO Rider |
$72.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
|
