|
HC TOES
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Central Health Plan Commercial |
$592.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
|
|
HC TOES
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$17.82 |
| Max. Negotiated Rate |
$666.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.82
|
| Rate for Payer: Blue Shield of California Commercial |
$449.18
|
| Rate for Payer: Blue Shield of California EPN |
$293.78
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Central Health Plan Commercial |
$592.00
|
| Rate for Payer: Cigna of CA HMO |
$473.60
|
| Rate for Payer: Cigna of CA PPO |
$547.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$666.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$555.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
905353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.75
|
| Rate for Payer: Blue Shield of California Commercial |
$15.46
|
| Rate for Payer: Blue Shield of California EPN |
$10.08
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.60
|
| Rate for Payer: InnovAge PACE Commercial |
$10.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
915353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.55 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.75
|
| Rate for Payer: Blue Shield of California Commercial |
$15.46
|
| Rate for Payer: Blue Shield of California EPN |
$10.08
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$14.00
|
| Rate for Payer: Cigna of CA PPO |
$14.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.60
|
| Rate for Payer: InnovAge PACE Commercial |
$10.00
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$10.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Riverside University Health System MISP |
$8.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.00
|
| Rate for Payer: Vantage Medical Group Senior |
$17.00
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
915353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.46
|
| Rate for Payer: Blue Shield of California EPN |
$10.08
|
| Rate for Payer: Cash Price |
$11.00
|
| 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 Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
|
|
HC TOE TAP SHOE ADD
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT L3550
|
| Hospital Charge Code |
905353550
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Blue Shield of California Commercial |
$15.46
|
| Rate for Payer: Blue Shield of California EPN |
$10.08
|
| Rate for Payer: Cash Price |
$11.00
|
| 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 Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.51
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.55
|
|
|
HC TOMO BILAT DIAG
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
900377062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Cash Price |
$352.55
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.40
|
| Rate for Payer: EPIC Health Plan Senior |
$256.40
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$396.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
|
|
HC TOMO BILAT DIAG
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 77062
|
| Hospital Charge Code |
900377062
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$128.20 |
| Max. Negotiated Rate |
$576.90 |
| Rate for Payer: Adventist Health Commercial |
$128.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$389.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$544.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$352.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$461.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$376.46
|
| Rate for Payer: Blue Shield of California Commercial |
$389.09
|
| Rate for Payer: Blue Shield of California EPN |
$254.48
|
| Rate for Payer: Cash Price |
$352.55
|
| Rate for Payer: Cash Price |
$352.55
|
| Rate for Payer: Central Health Plan Commercial |
$512.80
|
| Rate for Payer: Cigna of CA HMO |
$410.24
|
| Rate for Payer: Cigna of CA PPO |
$474.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$544.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$544.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$544.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$256.40
|
| Rate for Payer: EPIC Health Plan Senior |
$256.40
|
| Rate for Payer: Galaxy Health WC |
$544.85
|
| Rate for Payer: Global Benefits Group Commercial |
$384.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$576.90
|
| Rate for Payer: InnovAge PACE Commercial |
$320.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$427.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$396.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$448.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$448.70
|
| Rate for Payer: Multiplan Commercial |
$480.75
|
| Rate for Payer: Networks By Design Commercial |
$416.65
|
| Rate for Payer: Prime Health Services Commercial |
$544.85
|
| Rate for Payer: Riverside University Health System MISP |
$256.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$384.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$384.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.06
|
| Rate for Payer: United Healthcare All Other HMO |
$241.06
|
| Rate for Payer: United Healthcare HMO Rider |
$241.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$544.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$544.85
|
| Rate for Payer: Vantage Medical Group Senior |
$544.85
|
|
|
HC TOMO BILAT SCREENING
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
900377063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$221.87 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$221.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.13
|
| Rate for Payer: Blue Shield of California Commercial |
$70.41
|
| Rate for Payer: Blue Shield of California EPN |
$46.05
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: Cigna of CA HMO |
$74.24
|
| Rate for Payer: Cigna of CA PPO |
$85.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.73
|
| Rate for Payer: InnovAge PACE Commercial |
$58.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
| Rate for Payer: Riverside University Health System MISP |
$46.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.60
|
| Rate for Payer: Vantage Medical Group Senior |
$98.60
|
|
|
HC TOMO BILAT SCREENING
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 77063
|
| Hospital Charge Code |
900377063
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$23.20 |
| Max. Negotiated Rate |
$104.40 |
| Rate for Payer: Adventist Health Commercial |
$23.20
|
| Rate for Payer: Cash Price |
$63.80
|
| Rate for Payer: Central Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Senior |
$46.40
|
| Rate for Payer: Galaxy Health WC |
$98.60
|
| Rate for Payer: Global Benefits Group Commercial |
$69.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$87.00
|
| Rate for Payer: Networks By Design Commercial |
$75.40
|
| Rate for Payer: Prime Health Services Commercial |
$98.60
|
|
|
HC TOMOGRAPHY COMPLEX MOTION BODY SEC
|
Facility
|
IP
|
$661.00
|
|
|
Service Code
|
CPT 76101
|
| Hospital Charge Code |
909001156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Adventist Health Commercial |
$132.20
|
| Rate for Payer: Cash Price |
$363.55
|
| Rate for Payer: Central Health Plan Commercial |
$528.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.40
|
| Rate for Payer: EPIC Health Plan Senior |
$264.40
|
| Rate for Payer: Galaxy Health WC |
$561.85
|
| Rate for Payer: Global Benefits Group Commercial |
$396.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$594.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$440.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$409.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.20
|
| Rate for Payer: Multiplan Commercial |
$495.75
|
| Rate for Payer: Networks By Design Commercial |
$429.65
|
| Rate for Payer: Prime Health Services Commercial |
$561.85
|
|
|
HC TOMOGRAPHY COMPLEX MOTION BODY SEC
|
Facility
|
OP
|
$661.00
|
|
|
Service Code
|
CPT 76101
|
| Hospital Charge Code |
909001156
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$60.10 |
| Max. Negotiated Rate |
$594.90 |
| Rate for Payer: Adventist Health Commercial |
$132.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$401.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$561.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$363.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$495.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$296.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.10
|
| Rate for Payer: Blue Shield of California Commercial |
$401.23
|
| Rate for Payer: Blue Shield of California EPN |
$262.42
|
| Rate for Payer: Cash Price |
$363.55
|
| Rate for Payer: Cash Price |
$363.55
|
| Rate for Payer: Central Health Plan Commercial |
$528.80
|
| Rate for Payer: Cigna of CA HMO |
$423.04
|
| Rate for Payer: Cigna of CA PPO |
$489.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$561.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$561.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.40
|
| Rate for Payer: EPIC Health Plan Senior |
$264.40
|
| Rate for Payer: Galaxy Health WC |
$561.85
|
| Rate for Payer: Global Benefits Group Commercial |
$396.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$594.90
|
| Rate for Payer: InnovAge PACE Commercial |
$330.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$440.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$409.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$462.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$462.70
|
| Rate for Payer: Multiplan Commercial |
$495.75
|
| Rate for Payer: Networks By Design Commercial |
$429.65
|
| Rate for Payer: Prime Health Services Commercial |
$561.85
|
| Rate for Payer: Riverside University Health System MISP |
$264.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$396.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$396.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.50
|
| Rate for Payer: United Healthcare All Other HMO |
$330.50
|
| Rate for Payer: United Healthcare HMO Rider |
$330.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$561.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.85
|
| Rate for Payer: Vantage Medical Group Senior |
$561.85
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$613.80 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Central Health Plan Commercial |
$545.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$613.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| 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 |
$53.12 |
| Max. Negotiated Rate |
$613.80 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$414.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.12
|
| Rate for Payer: Blue Shield of California Commercial |
$413.97
|
| Rate for Payer: Blue Shield of California EPN |
$270.75
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Cash Price |
$375.10
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$613.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| 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 |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$409.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC TOMO GUIDED BREAST BX
|
Facility
|
IP
|
$13,306.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
906609499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,661.20 |
| Max. Negotiated Rate |
$11,975.40 |
| Rate for Payer: Adventist Health Commercial |
$2,661.20
|
| Rate for Payer: Cash Price |
$7,318.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,644.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,322.40
|
| Rate for Payer: Galaxy Health WC |
$11,310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,983.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,975.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,875.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,069.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,236.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,661.20
|
| Rate for Payer: Multiplan Commercial |
$9,979.50
|
| Rate for Payer: Networks By Design Commercial |
$8,648.90
|
| Rate for Payer: Prime Health Services Commercial |
$11,310.10
|
|
|
HC TOMO GUIDED BREAST BX
|
Facility
|
OP
|
$13,306.00
|
|
|
Service Code
|
CPT 19499
|
| Hospital Charge Code |
906609499
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,661.20 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,661.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,865.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,865.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,752.28
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$7,318.30
|
| Rate for Payer: Cash Price |
$7,318.30
|
| Rate for Payer: Cash Price |
$7,318.30
|
| Rate for Payer: Central Health Plan Commercial |
$10,644.80
|
| Rate for Payer: Cigna of CA HMO |
$8,515.84
|
| Rate for Payer: Cigna of CA PPO |
$9,846.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,352.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,865.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,568.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,865.48
|
| Rate for Payer: Galaxy Health WC |
$11,310.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,983.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,975.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,979.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,865.48
|
| Rate for Payer: InnovAge PACE Commercial |
$7,298.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,875.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,865.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,661.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,519.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,519.74
|
| Rate for Payer: Multiplan Commercial |
$9,979.50
|
| Rate for Payer: Multiplan WC |
$7,752.28
|
| Rate for Payer: Networks By Design Commercial |
$8,648.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,865.48
|
| Rate for Payer: Preferred Health Network WC |
$7,910.49
|
| Rate for Payer: Prime Health Services Commercial |
$11,310.10
|
| Rate for Payer: Prime Health Services Medicare |
$5,157.41
|
| Rate for Payer: Prime Health Services WC |
$7,673.18
|
| Rate for Payer: Riverside University Health System MISP |
$5,352.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,983.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,865.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,298.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,352.03
|
| Rate for Payer: Vantage Medical Group Senior |
$4,865.48
|
|
|
HC TOMO UNILAT
|
Facility
|
IP
|
$467.00
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
900377061
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$420.30 |
| Rate for Payer: Adventist Health Commercial |
$93.40
|
| Rate for Payer: Cash Price |
$256.85
|
| Rate for Payer: Central Health Plan Commercial |
$373.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$186.80
|
| Rate for Payer: Galaxy Health WC |
$396.95
|
| Rate for Payer: Global Benefits Group Commercial |
$280.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$420.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$311.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$289.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.40
|
| Rate for Payer: Multiplan Commercial |
$350.25
|
| Rate for Payer: Networks By Design Commercial |
$303.55
|
| Rate for Payer: Prime Health Services Commercial |
$396.95
|
|
|
HC TOMO UNILAT
|
Facility
|
OP
|
$467.00
|
|
|
Service Code
|
CPT 77061
|
| Hospital Charge Code |
900377061
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$420.30 |
| Rate for Payer: Adventist Health Commercial |
$93.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$283.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$350.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$274.27
|
| Rate for Payer: Blue Shield of California Commercial |
$283.47
|
| Rate for Payer: Blue Shield of California EPN |
$185.40
|
| Rate for Payer: Cash Price |
$256.85
|
| Rate for Payer: Cash Price |
$256.85
|
| Rate for Payer: Central Health Plan Commercial |
$373.60
|
| Rate for Payer: Cigna of CA HMO |
$298.88
|
| Rate for Payer: Cigna of CA PPO |
$345.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$396.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$396.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.80
|
| Rate for Payer: EPIC Health Plan Senior |
$186.80
|
| Rate for Payer: Galaxy Health WC |
$396.95
|
| Rate for Payer: Global Benefits Group Commercial |
$280.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$420.30
|
| Rate for Payer: InnovAge PACE Commercial |
$233.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$311.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$289.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$326.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$326.90
|
| Rate for Payer: Multiplan Commercial |
$350.25
|
| Rate for Payer: Networks By Design Commercial |
$303.55
|
| Rate for Payer: Prime Health Services Commercial |
$396.95
|
| Rate for Payer: Riverside University Health System MISP |
$186.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$280.20
|
| 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 Commercial/Exchange |
$396.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$396.95
|
| Rate for Payer: Vantage Medical Group Senior |
$396.95
|
|
|
HC TORSION CONTROL ANKLE JOINT ADDITION LE
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L2375
|
| Hospital Charge Code |
915352375
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Blue Shield of California Commercial |
$187.84
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$133.65
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| 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 |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
|
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 |
$79.58 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| 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 |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.71
|
| Rate for Payer: Blue Shield of California Commercial |
$187.84
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| 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 Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$120.71
|
| Rate for Payer: InnovAge PACE Commercial |
$121.50
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| 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 |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| 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: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Blue Shield of California Commercial |
$187.84
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$133.65
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| 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 |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
|
HC TORSION CONTROL ANKLE JOINT ADDITION LE
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L2375
|
| Hospital Charge Code |
915352375
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.58 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| 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 |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.71
|
| Rate for Payer: Blue Shield of California Commercial |
$187.84
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| 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 Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$120.71
|
| Rate for Payer: InnovAge PACE Commercial |
$121.50
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| 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 |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC TORSION CONTROL KNEE JOINT ADDITION LE
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT L2380
|
| Hospital Charge Code |
915352380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.50 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.46
|
| Rate for Payer: Blue Shield of California Commercial |
$154.60
|
| Rate for Payer: Blue Shield of California EPN |
$100.80
|
| Rate for Payer: Cash Price |
$110.00
|
| Rate for Payer: Cash Price |
$110.00
|
| 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: Dignity Health Commercial/Exchange |
$170.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$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: Inland Empire Health Plan (IEHP) medi-cal |
$142.52
|
| Rate for Payer: InnovAge PACE Commercial |
$100.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$133.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.00
|
| 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: Riverside University Health System MISP |
$80.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.00
|
| Rate for Payer: Vantage Medical Group Senior |
$170.00
|
|
|
HC TORSION CONTROL KNEE JOINT ADDITION LE
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT L2380
|
| Hospital Charge Code |
915352380
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.60
|
| Rate for Payer: Blue Shield of California EPN |
$100.80
|
| Rate for Payer: Cash Price |
$110.00
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| 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 |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
|
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: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Blue Shield of California Commercial |
$154.60
|
| Rate for Payer: Blue Shield of California EPN |
$100.80
|
| Rate for Payer: Cash Price |
$110.00
|
| 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 Senior |
$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: Kaiser Permanente of CA Medicare Advantage |
$123.80
|
| 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 |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.06
|
| Rate for Payer: United Healthcare All Other HMO |
$73.06
|
| Rate for Payer: United Healthcare HMO Rider |
$71.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.50
|
|
