|
HC FX OX SHOE INSERT
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT L2180
|
| Hospital Charge Code |
915352180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$199.80 |
| Rate for Payer: Adventist Health Commercial |
$91.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.38
|
| Rate for Payer: Blue Shield of California Commercial |
$171.61
|
| Rate for Payer: Blue Shield of California EPN |
$111.89
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Central Health Plan Commercial |
$177.60
|
| Rate for Payer: Cigna of CA HMO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$188.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$188.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.80
|
| Rate for Payer: EPIC Health Plan Senior |
$88.80
|
| Rate for Payer: Galaxy Health WC |
$188.70
|
| Rate for Payer: Global Benefits Group Commercial |
$133.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$199.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.71
|
| Rate for Payer: InnovAge PACE Commercial |
$111.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$155.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$155.40
|
| Rate for Payer: Multiplan Commercial |
$166.50
|
| Rate for Payer: Networks By Design Commercial |
$111.00
|
| Rate for Payer: Prime Health Services Commercial |
$188.70
|
| Rate for Payer: Riverside University Health System MISP |
$88.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$83.32
|
| Rate for Payer: United Healthcare All Other HMO |
$81.10
|
| Rate for Payer: United Healthcare HMO Rider |
$79.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$188.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.70
|
| Rate for Payer: Vantage Medical Group Senior |
$188.70
|
|
|
HC FX OX WAIST BELT
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
915352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.52
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.09
|
| Rate for Payer: InnovAge PACE Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FX OX WAIST BELT
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
915352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC FX OX WAIST BELT
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
905352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC FX OX WAIST BELT
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L2190
|
| Hospital Charge Code |
905352190
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.52
|
| Rate for Payer: Blue Shield of California Commercial |
$102.04
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$76.09
|
| Rate for Payer: InnovAge PACE Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FX OX WRIST
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
905353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$559.65
|
| Rate for Payer: Blue Shield of California EPN |
$364.90
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Central Health Plan Commercial |
$579.20
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.80
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: Networks By Design Commercial |
$470.60
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
|
|
HC FX OX WRIST
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
915353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.80 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Adventist Health Commercial |
$144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$559.65
|
| Rate for Payer: Blue Shield of California EPN |
$364.90
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Central Health Plan Commercial |
$579.20
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$651.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.80
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: Networks By Design Commercial |
$470.60
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
|
|
HC FX OX WRIST
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
915353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.11 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Adventist Health Commercial |
$296.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$398.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$543.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.21
|
| Rate for Payer: Blue Shield of California Commercial |
$559.65
|
| Rate for Payer: Blue Shield of California EPN |
$364.90
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Central Health Plan Commercial |
$579.20
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$615.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$615.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$615.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$651.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.49
|
| Rate for Payer: InnovAge PACE Commercial |
$362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$506.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$506.80
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: Networks By Design Commercial |
$362.00
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: Riverside University Health System MISP |
$289.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$434.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$434.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$615.40
|
| Rate for Payer: Vantage Medical Group Senior |
$615.40
|
|
|
HC FX OX WRIST
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT L3984
|
| Hospital Charge Code |
905353984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.11 |
| Max. Negotiated Rate |
$651.60 |
| Rate for Payer: Adventist Health Commercial |
$296.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$398.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$543.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.21
|
| Rate for Payer: Blue Shield of California Commercial |
$559.65
|
| Rate for Payer: Blue Shield of California EPN |
$364.90
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Central Health Plan Commercial |
$579.20
|
| Rate for Payer: Cigna of CA HMO |
$506.80
|
| Rate for Payer: Cigna of CA PPO |
$506.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$615.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$615.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$615.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: EPIC Health Plan Senior |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$651.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$290.49
|
| Rate for Payer: InnovAge PACE Commercial |
$362.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$506.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$506.80
|
| Rate for Payer: Multiplan Commercial |
$543.00
|
| Rate for Payer: Networks By Design Commercial |
$362.00
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: Riverside University Health System MISP |
$289.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$434.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$434.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$271.72
|
| Rate for Payer: United Healthcare All Other HMO |
$264.48
|
| Rate for Payer: United Healthcare HMO Rider |
$258.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$615.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$615.40
|
| Rate for Payer: Vantage Medical Group Senior |
$615.40
|
|
|
HC GA-67 GALLIUM PER MCI
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT A9556
|
| Hospital Charge Code |
909301528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Blue Shield of California Commercial |
$268.23
|
| Rate for Payer: Blue Shield of California EPN |
$174.89
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
|
|
HC GA-67 GALLIUM PER MCI
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT A9556
|
| Hospital Charge Code |
909301528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.79
|
| Rate for Payer: Blue Shield of California Commercial |
$212.02
|
| Rate for Payer: Blue Shield of California EPN |
$138.45
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Cash Price |
$156.15
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$242.90
|
| Rate for Payer: Cigna of CA PPO |
$242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.23
|
| Rate for Payer: InnovAge PACE Commercial |
$173.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$256.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.90
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$173.50
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: Riverside University Health System MISP |
$138.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$130.23
|
| Rate for Payer: United Healthcare All Other HMO |
$126.76
|
| Rate for Payer: United Healthcare HMO Rider |
$124.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$294.95
|
|
|
HC GADOLINIUM MR CONTRAST PER ML
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
909081000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.05
|
| Rate for Payer: Blue Shield of California Commercial |
$7.33
|
| Rate for Payer: Blue Shield of California EPN |
$4.79
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.49
|
| Rate for Payer: InnovAge PACE Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Riverside University Health System MISP |
$4.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.20
|
|
|
HC GADOLINIUM MR CONTRAST PER ML
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
CPT A9579
|
| Hospital Charge Code |
909081000
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$10.80 |
| Rate for Payer: Adventist Health Commercial |
$2.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.28
|
| Rate for Payer: Blue Shield of California EPN |
$6.05
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$8.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4.80
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$9.00
|
| Rate for Payer: Networks By Design Commercial |
$6.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.93
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.08
|
| Rate for Payer: Blue Shield of California Commercial |
$63.13
|
| Rate for Payer: Blue Shield of California EPN |
$41.29
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: Cigna of CA HMO |
$66.56
|
| Rate for Payer: Cigna of CA PPO |
$76.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.71
|
| Rate for Payer: InnovAge PACE Commercial |
$52.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: Riverside University Health System MISP |
$41.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.03
|
| Rate for Payer: United Healthcare All Other HMO |
$37.99
|
| Rate for Payer: United Healthcare HMO Rider |
$37.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.40
|
| Rate for Payer: Vantage Medical Group Senior |
$88.40
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$20.80 |
| Max. Negotiated Rate |
$93.60 |
| Rate for Payer: Adventist Health Commercial |
$20.80
|
| Rate for Payer: Blue Shield of California Commercial |
$80.39
|
| Rate for Payer: Blue Shield of California EPN |
$52.42
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Central Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Senior |
$41.60
|
| Rate for Payer: Galaxy Health WC |
$88.40
|
| Rate for Payer: Global Benefits Group Commercial |
$62.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.80
|
| Rate for Payer: Multiplan Commercial |
$78.00
|
| Rate for Payer: Networks By Design Commercial |
$67.60
|
| Rate for Payer: Prime Health Services Commercial |
$88.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.03
|
| Rate for Payer: United Healthcare All Other HMO |
$37.99
|
| Rate for Payer: United Healthcare HMO Rider |
$37.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.06
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| 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 |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.40
|
| Rate for Payer: InnovAge PACE Commercial |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Riverside University Health System MISP |
$87.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| 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 |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900417116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| 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 |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.40
|
| Rate for Payer: InnovAge PACE Commercial |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Riverside University Health System MISP |
$87.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| 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 |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103143
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900417116
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC GAIT TRAINING 15 MIN PT
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103143
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$89.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.50
|
| 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 |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.40
|
| Rate for Payer: InnovAge PACE Commercial |
$109.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Riverside University Health System MISP |
$87.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| 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 |
$185.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.30
|
| Rate for Payer: Vantage Medical Group Senior |
$185.30
|
|
|
HC GAIT TRAINING 30 MIN PT
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103363
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$19.40 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$134.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$198.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$245.25
|
| 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 |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Central Health Plan Commercial |
$261.60
|
| Rate for Payer: Cigna of CA HMO |
$209.28
|
| Rate for Payer: Cigna of CA PPO |
$241.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$294.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.40
|
| Rate for Payer: InnovAge PACE Commercial |
$163.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$228.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$228.90
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Riverside University Health System MISP |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.20
|
| 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 |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC GAIT TRAINING 30 MIN PT
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
905103363
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$65.40 |
| Max. Negotiated Rate |
$294.30 |
| Rate for Payer: Adventist Health Commercial |
$65.40
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Central Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Senior |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$294.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$202.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.40
|
| Rate for Payer: Multiplan Commercial |
$245.25
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$358.52 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,442.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,766.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$358.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1,441.62
|
| Rate for Payer: Blue Shield of California EPN |
$942.88
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Cigna of CA HMO |
$1,520.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$2,018.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,137.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$500.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,584.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: Networks By Design Commercial |
$1,543.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$2,018.75
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,425.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,425.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$950.00
|
| Rate for Payer: Galaxy Health WC |
$2,018.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,137.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,584.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$904.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,470.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: Networks By Design Commercial |
$1,543.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,018.75
|
|
