|
HC DXA BONE DENSITY APPENDICULAR
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
900377081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$297.00 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.00
|
| Rate for Payer: EPIC Health Plan Senior |
$132.00
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
|
|
HC DXA BONE DENSITY APPENDICULAR
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
900377081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.17 |
| Max. Negotiated Rate |
$315.80 |
| Rate for Payer: Adventist Health Commercial |
$66.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$200.41
|
| 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 |
$315.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.09
|
| Rate for Payer: Blue Shield of California Commercial |
$200.31
|
| Rate for Payer: Blue Shield of California EPN |
$131.01
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$211.20
|
| Rate for Payer: Cigna of CA PPO |
$244.20
|
| 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 |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.17
|
| 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 |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| 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 |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| 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 |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.21
|
| Rate for Payer: United Healthcare All Other HMO |
$82.21
|
| Rate for Payer: United Healthcare HMO Rider |
$82.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.21
|
| 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 DXA BONE DENSITY AXIAL
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
900377080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.94 |
| Max. Negotiated Rate |
$594.09 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.59
|
| 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 |
$594.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.57
|
| Rate for Payer: Blue Shield of California Commercial |
$348.42
|
| Rate for Payer: Blue Shield of California EPN |
$227.88
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Central Health Plan Commercial |
$459.20
|
| Rate for Payer: Cigna of CA HMO |
$367.36
|
| Rate for Payer: Cigna of CA PPO |
$424.76
|
| 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 |
$487.90
|
| Rate for Payer: Global Benefits Group Commercial |
$344.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.94
|
| 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 |
$382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| 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 |
$430.50
|
| Rate for Payer: Networks By Design Commercial |
$373.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$487.90
|
| 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 |
$344.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$344.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.99
|
| Rate for Payer: United Healthcare All Other HMO |
$182.99
|
| Rate for Payer: United Healthcare HMO Rider |
$182.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.99
|
| 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 DXA BONE DENSITY AXIAL
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
900377080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.80 |
| Max. Negotiated Rate |
$516.60 |
| Rate for Payer: Adventist Health Commercial |
$114.80
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Central Health Plan Commercial |
$459.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$229.60
|
| Rate for Payer: EPIC Health Plan Senior |
$229.60
|
| Rate for Payer: Galaxy Health WC |
$487.90
|
| Rate for Payer: Global Benefits Group Commercial |
$344.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$382.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$355.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.80
|
| Rate for Payer: Multiplan Commercial |
$430.50
|
| Rate for Payer: Networks By Design Commercial |
$373.10
|
| Rate for Payer: Prime Health Services Commercial |
$487.90
|
|
|
HC DXA BONE DNSTY AXIAL W FX EVAL
|
Facility
|
IP
|
$536.00
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
900377085
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$482.40 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Central Health Plan Commercial |
$428.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Senior |
$214.40
|
| Rate for Payer: Galaxy Health WC |
$455.60
|
| Rate for Payer: Global Benefits Group Commercial |
$321.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$482.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$357.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$204.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.20
|
| Rate for Payer: Multiplan Commercial |
$402.00
|
| Rate for Payer: Networks By Design Commercial |
$348.40
|
| Rate for Payer: Prime Health Services Commercial |
$455.60
|
|
|
HC DXA BONE DNSTY AXIAL W FX EVAL
|
Facility
|
OP
|
$536.00
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
900377085
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.01 |
| Max. Negotiated Rate |
$482.40 |
| Rate for Payer: Adventist Health Commercial |
$107.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$325.51
|
| 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 |
$431.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.65
|
| Rate for Payer: Blue Shield of California Commercial |
$325.35
|
| Rate for Payer: Blue Shield of California EPN |
$212.79
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Cash Price |
$241.20
|
| Rate for Payer: Central Health Plan Commercial |
$428.80
|
| Rate for Payer: Cigna of CA HMO |
$343.04
|
| Rate for Payer: Cigna of CA PPO |
$396.64
|
| 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 |
$455.60
|
| Rate for Payer: Global Benefits Group Commercial |
$321.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$482.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.01
|
| 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 |
$357.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.20
|
| 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 |
$402.00
|
| Rate for Payer: Networks By Design Commercial |
$348.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$455.60
|
| 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 |
$321.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.15
|
| Rate for Payer: United Healthcare All Other HMO |
$243.15
|
| Rate for Payer: United Healthcare HMO Rider |
$243.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.15
|
| 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 DXA FX ASSESSMENT
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 77086
|
| Hospital Charge Code |
900377086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC DXA FX ASSESSMENT
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 77086
|
| Hospital Charge Code |
900377086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$280.98 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$162.76
|
| 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 |
$280.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.03
|
| Rate for Payer: Blue Shield of California Commercial |
$162.68
|
| Rate for Payer: Blue Shield of California EPN |
$106.40
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| 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 |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.98
|
| 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 |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| 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 |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| 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 |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.90
|
| Rate for Payer: United Healthcare All Other HMO |
$151.90
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.90
|
| 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 DYNAMIC FLEXOR HINGE,RECIPROCA
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
903203901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Adventist Health Commercial |
$61.00
|
| Rate for Payer: Blue Shield of California Commercial |
$235.76
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$198.25
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
|
|
HC DYNAMIC FLEXOR HINGE,RECIPROCA
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
903203901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$99.89 |
| Max. Negotiated Rate |
$1,549.41 |
| Rate for Payer: Adventist Health Commercial |
$125.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.13
|
| Rate for Payer: Blue Shield of California Commercial |
$235.76
|
| Rate for Payer: Blue Shield of California EPN |
$153.72
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,402.63
|
| Rate for Payer: InnovAge PACE Commercial |
$152.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$188.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.50
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Riverside University Health System MISP |
$122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.47
|
| Rate for Payer: United Healthcare All Other HMO |
$111.42
|
| Rate for Payer: United Healthcare HMO Rider |
$109.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC DYNAMIC FLEXOR HINGE,WRIST/FIN
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
903203900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.84 |
| Max. Negotiated Rate |
$1,163.86 |
| Rate for Payer: Adventist Health Commercial |
$175.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.78
|
| Rate for Payer: Blue Shield of California Commercial |
$330.07
|
| Rate for Payer: Blue Shield of California EPN |
$215.21
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,053.60
|
| Rate for Payer: InnovAge PACE Commercial |
$213.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.90
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$213.50
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: Riverside University Health System MISP |
$170.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.25
|
| Rate for Payer: United Healthcare All Other HMO |
$155.98
|
| Rate for Payer: United Healthcare HMO Rider |
$152.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.95
|
| Rate for Payer: Vantage Medical Group Senior |
$362.95
|
|
|
HC DYNAMIC FLEXOR HINGE,WRIST/FIN
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
903203900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Adventist Health Commercial |
$85.40
|
| Rate for Payer: Blue Shield of California Commercial |
$330.07
|
| Rate for Payer: Blue Shield of California EPN |
$215.21
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Senior |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$160.25
|
| Rate for Payer: United Healthcare All Other HMO |
$155.98
|
| Rate for Payer: United Healthcare HMO Rider |
$152.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.84
|
|
|
HC DYNAMIC PLYON
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
905355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.39 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.59
|
| Rate for Payer: Blue Shield of California Commercial |
$390.37
|
| Rate for Payer: Blue Shield of California EPN |
$254.52
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$212.20
|
| Rate for Payer: InnovAge PACE Commercial |
$252.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Riverside University Health System MISP |
$202.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC DYNAMIC PLYON
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
905355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Blue Shield of California Commercial |
$390.37
|
| Rate for Payer: Blue Shield of California EPN |
$254.52
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC DYNAMIC PLYON
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
915355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Blue Shield of California Commercial |
$390.37
|
| Rate for Payer: Blue Shield of California EPN |
$254.52
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC DYNAMIC PLYON
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
915355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.39 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.59
|
| Rate for Payer: Blue Shield of California Commercial |
$390.37
|
| Rate for Payer: Blue Shield of California EPN |
$254.52
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$212.20
|
| Rate for Payer: InnovAge PACE Commercial |
$252.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Riverside University Health System MISP |
$202.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,865.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,335.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,905.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,095.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Networks By Design Commercial |
$3,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,865.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,335.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,905.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,095.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,000.00
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Networks By Design Commercial |
$3,250.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,637.50 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,936.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,865.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,335.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,905.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,095.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,050.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,250.00
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,637.50 |
| Max. Negotiated Rate |
$4,500.00 |
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,936.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,865.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,520.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,000.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,500.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,500.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,335.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,905.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,095.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,050.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$3,750.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,000.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,250.00
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
OP
|
$1,048.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$576.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$786.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$507.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$615.49
|
| Rate for Payer: Blue Shield of California Commercial |
$636.14
|
| Rate for Payer: Blue Shield of California EPN |
$416.06
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: Cigna of CA HMO |
$670.72
|
| Rate for Payer: Cigna of CA PPO |
$775.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$890.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$890.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$890.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$260.63
|
| Rate for Payer: InnovAge PACE Commercial |
$524.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$733.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$733.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
| Rate for Payer: Riverside University Health System MISP |
$419.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$628.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$628.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$524.00
|
| Rate for Payer: United Healthcare All Other HMO |
$524.00
|
| Rate for Payer: United Healthcare HMO Rider |
$524.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$524.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$890.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$890.80
|
| Rate for Payer: Vantage Medical Group Senior |
$890.80
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
IP
|
$1,048.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$209.60 |
| Max. Negotiated Rate |
$943.20 |
| Rate for Payer: Adventist Health Commercial |
$209.60
|
| Rate for Payer: Cash Price |
$471.60
|
| Rate for Payer: Central Health Plan Commercial |
$838.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.20
|
| Rate for Payer: EPIC Health Plan Senior |
$419.20
|
| Rate for Payer: Galaxy Health WC |
$890.80
|
| Rate for Payer: Global Benefits Group Commercial |
$628.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$943.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$699.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$399.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$648.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.60
|
| Rate for Payer: Multiplan Commercial |
$786.00
|
| Rate for Payer: Networks By Design Commercial |
$681.20
|
| Rate for Payer: Prime Health Services Commercial |
$890.80
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,122.00
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,870.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,068.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,736.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$320.18 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$561.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,542.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,103.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,358.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,647.38
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,795.20
|
| Rate for Payer: Cigna of CA PPO |
$2,075.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,384.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,384.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,122.00
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$320.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,402.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,870.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,736.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,963.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,963.50
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,683.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,384.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,384.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,384.25
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
