|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$452.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.79
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| Rate for Payer: Central Health Plan Commercial |
$882.40
|
| Rate for Payer: Cigna of CA HMO |
$705.92
|
| Rate for Payer: Cigna of CA PPO |
$816.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$992.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$827.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$716.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$661.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$220.60 |
| Max. Negotiated Rate |
$992.70 |
| Rate for Payer: Adventist Health Commercial |
$220.60
|
| Rate for Payer: Cash Price |
$606.65
|
| Rate for Payer: Central Health Plan Commercial |
$882.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$441.20
|
| Rate for Payer: EPIC Health Plan Senior |
$441.20
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$992.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$420.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$682.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.60
|
| Rate for Payer: Multiplan Commercial |
$827.25
|
| Rate for Payer: Networks By Design Commercial |
$716.95
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$220.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| Rate for Payer: Cash Price |
$606.65
|
| Rate for Payer: Central Health Plan Commercial |
$882.40
|
| Rate for Payer: Cigna of CA HMO |
$705.92
|
| Rate for Payer: Cigna of CA PPO |
$816.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$937.55
|
| Rate for Payer: Global Benefits Group Commercial |
$661.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$992.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$735.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$220.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$827.25
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$716.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.64
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$937.55
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$661.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$551.50
|
| Rate for Payer: United Healthcare All Other HMO |
$551.50
|
| Rate for Payer: United Healthcare HMO Rider |
$551.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$551.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC WEDGE, FOAM, 15 DEGREE. PAIR
|
Facility
|
OP
|
$250.81
|
|
| Hospital Charge Code |
901698446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$225.73 |
| Rate for Payer: Adventist Health Commercial |
$50.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.30
|
| Rate for Payer: Blue Shield of California Commercial |
$153.24
|
| Rate for Payer: Blue Shield of California EPN |
$100.07
|
| Rate for Payer: Cash Price |
$137.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.65
|
| Rate for Payer: Cigna of CA HMO |
$160.52
|
| Rate for Payer: Cigna of CA PPO |
$185.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$213.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.32
|
| Rate for Payer: EPIC Health Plan Senior |
$100.32
|
| Rate for Payer: Galaxy Health WC |
$213.19
|
| Rate for Payer: Global Benefits Group Commercial |
$150.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.73
|
| Rate for Payer: InnovAge PACE Commercial |
$125.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.57
|
| Rate for Payer: Multiplan Commercial |
$188.11
|
| Rate for Payer: Networks By Design Commercial |
$163.03
|
| Rate for Payer: Prime Health Services Commercial |
$213.19
|
| Rate for Payer: Riverside University Health System MISP |
$100.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.41
|
| Rate for Payer: United Healthcare All Other HMO |
$125.41
|
| Rate for Payer: United Healthcare HMO Rider |
$125.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.19
|
| Rate for Payer: Vantage Medical Group Senior |
$213.19
|
|
|
HC WEDGE, FOAM, 15 DEGREE. PAIR
|
Facility
|
IP
|
$250.81
|
|
| Hospital Charge Code |
901698446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$225.73 |
| Rate for Payer: Adventist Health Commercial |
$50.16
|
| Rate for Payer: Cash Price |
$137.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.32
|
| Rate for Payer: EPIC Health Plan Senior |
$100.32
|
| Rate for Payer: Galaxy Health WC |
$213.19
|
| Rate for Payer: Global Benefits Group Commercial |
$150.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.16
|
| Rate for Payer: Multiplan Commercial |
$188.11
|
| Rate for Payer: Networks By Design Commercial |
$163.03
|
| Rate for Payer: Prime Health Services Commercial |
$213.19
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR
|
Facility
|
OP
|
$227.99
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$205.19 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$138.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$170.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.90
|
| Rate for Payer: Blue Shield of California Commercial |
$139.30
|
| Rate for Payer: Blue Shield of California EPN |
$90.97
|
| Rate for Payer: Cash Price |
$125.39
|
| Rate for Payer: Central Health Plan Commercial |
$182.39
|
| Rate for Payer: Cigna of CA HMO |
$145.91
|
| Rate for Payer: Cigna of CA PPO |
$168.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.79
|
| Rate for Payer: Global Benefits Group Commercial |
$136.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.19
|
| Rate for Payer: InnovAge PACE Commercial |
$114.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$159.59
|
| Rate for Payer: Multiplan Commercial |
$170.99
|
| Rate for Payer: Networks By Design Commercial |
$148.19
|
| Rate for Payer: Prime Health Services Commercial |
$193.79
|
| Rate for Payer: Riverside University Health System MISP |
$91.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.00
|
| Rate for Payer: United Healthcare All Other HMO |
$114.00
|
| Rate for Payer: United Healthcare HMO Rider |
$114.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$193.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.79
|
| Rate for Payer: Vantage Medical Group Senior |
$193.79
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR
|
Facility
|
IP
|
$227.99
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$205.19 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$125.39
|
| Rate for Payer: Central Health Plan Commercial |
$182.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.79
|
| Rate for Payer: Global Benefits Group Commercial |
$136.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$141.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$170.99
|
| Rate for Payer: Networks By Design Commercial |
$148.19
|
| Rate for Payer: Prime Health Services Commercial |
$193.79
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR XL
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607586
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR XL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607586
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$213.85
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC WEDGE STBLIZR HEELMEDIX
|
Facility
|
OP
|
$41.49
|
|
| Hospital Charge Code |
901606283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$37.34 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.37
|
| Rate for Payer: Blue Shield of California Commercial |
$25.35
|
| Rate for Payer: Blue Shield of California EPN |
$16.55
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Central Health Plan Commercial |
$33.19
|
| Rate for Payer: Cigna of CA HMO |
$26.55
|
| Rate for Payer: Cigna of CA PPO |
$30.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.60
|
| Rate for Payer: EPIC Health Plan Senior |
$16.60
|
| Rate for Payer: Galaxy Health WC |
$35.27
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.34
|
| Rate for Payer: InnovAge PACE Commercial |
$20.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$31.12
|
| Rate for Payer: Networks By Design Commercial |
$26.97
|
| Rate for Payer: Prime Health Services Commercial |
$35.27
|
| Rate for Payer: Riverside University Health System MISP |
$16.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.75
|
| Rate for Payer: United Healthcare All Other HMO |
$20.75
|
| Rate for Payer: United Healthcare HMO Rider |
$20.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.27
|
| Rate for Payer: Vantage Medical Group Senior |
$35.27
|
|
|
HC WEDGE STBLIZR HEELMEDIX
|
Facility
|
IP
|
$41.49
|
|
| Hospital Charge Code |
901606283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.30 |
| Max. Negotiated Rate |
$37.34 |
| Rate for Payer: Adventist Health Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$22.82
|
| Rate for Payer: Central Health Plan Commercial |
$33.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.60
|
| Rate for Payer: EPIC Health Plan Senior |
$16.60
|
| Rate for Payer: Galaxy Health WC |
$35.27
|
| Rate for Payer: Global Benefits Group Commercial |
$24.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.30
|
| Rate for Payer: Multiplan Commercial |
$31.12
|
| Rate for Payer: Networks By Design Commercial |
$26.97
|
| Rate for Payer: Prime Health Services Commercial |
$35.27
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: Cigna of CA HMO |
$842.24
|
| Rate for Payer: Cigna of CA PPO |
$973.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: InnovAge PACE Commercial |
$506.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$337.45
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
| Rate for Payer: Prime Health Services Medicare |
$357.70
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$371.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$658.00
|
| Rate for Payer: United Healthcare All Other HMO |
$658.00
|
| Rate for Payer: United Healthcare HMO Rider |
$658.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$658.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Senior |
$526.40
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$501.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$814.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
|
OP
|
$1,316.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$539.56
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$799.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$772.89
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: Cigna of CA HMO |
$842.24
|
| Rate for Payer: Cigna of CA PPO |
$973.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: InnovAge PACE Commercial |
$506.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$337.45
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
| Rate for Payer: Prime Health Services Medicare |
$357.70
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$371.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$789.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$789.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
|
IP
|
$1,316.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$263.20 |
| Max. Negotiated Rate |
$1,184.40 |
| Rate for Payer: Adventist Health Commercial |
$263.20
|
| Rate for Payer: Cash Price |
$723.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,052.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$526.40
|
| Rate for Payer: EPIC Health Plan Senior |
$526.40
|
| Rate for Payer: Galaxy Health WC |
$1,118.60
|
| Rate for Payer: Global Benefits Group Commercial |
$789.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,184.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$877.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$501.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$814.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.20
|
| Rate for Payer: Multiplan Commercial |
$987.00
|
| Rate for Payer: Networks By Design Commercial |
$855.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,118.60
|
|
|
HC WEEKLY PHYSICS
|
Facility
|
OP
|
$2,538.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$94.74 |
| Max. Negotiated Rate |
$2,284.20 |
| Rate for Payer: Adventist Health Commercial |
$507.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$168.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,541.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$547.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,540.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,007.59
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,030.40
|
| Rate for Payer: Cigna of CA HMO |
$1,624.32
|
| Rate for Payer: Cigna of CA PPO |
$1,878.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| Rate for Payer: Galaxy Health WC |
$2,157.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,522.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,284.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: InnovAge PACE Commercial |
$253.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,692.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| Rate for Payer: Multiplan Commercial |
$1,903.50
|
| Rate for Payer: Networks By Design Commercial |
$1,649.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$168.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,157.30
|
| Rate for Payer: Prime Health Services Medicare |
$178.82
|
| Rate for Payer: Riverside University Health System MISP |
$185.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,522.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$168.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC WEEKLY PHYSICS
|
Facility
|
IP
|
$2,538.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$507.60 |
| Max. Negotiated Rate |
$2,284.20 |
| Rate for Payer: Adventist Health Commercial |
$507.60
|
| Rate for Payer: Cash Price |
$1,395.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,030.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,015.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,015.20
|
| Rate for Payer: Galaxy Health WC |
$2,157.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,522.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,284.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,692.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$966.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,571.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.60
|
| Rate for Payer: Multiplan Commercial |
$1,903.50
|
| Rate for Payer: Networks By Design Commercial |
$1,649.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,157.30
|
|
|
HC WET MOUNT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.11
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: InnovAge PACE Commercial |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.82
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Prime Health Services Medicare |
$6.17
|
| Rate for Payer: Riverside University Health System MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WET MOUNT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC WET MOUNT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC WET MOUNT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
900501279
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.86
|
| Rate for Payer: EPIC Health Plan Senior |
$5.82
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.82
|
| Rate for Payer: InnovAge PACE Commercial |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.82
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Prime Health Services Medicare |
$6.17
|
| Rate for Payer: Riverside University Health System MISP |
$6.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.00
|
| Rate for Payer: United Healthcare All Other HMO |
$98.00
|
| Rate for Payer: United Healthcare HMO Rider |
$98.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5.82
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$54.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: InnovAge PACE Commercial |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.10
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Riverside University Health System MISP |
$53.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC WHEELCHAIR MGMT 15 MIN OT
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
905103154
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.67 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$54.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: InnovAge PACE Commercial |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$93.10
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Riverside University Health System MISP |
$53.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.05
|
| Rate for Payer: Vantage Medical Group Senior |
$113.05
|
|
|
HC WHEELCHAIR MGMT 15 MIN OT
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
905103154
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$73.15
|
| Rate for Payer: Central Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$119.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$99.75
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
