|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
915350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.71 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,351.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,410.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,908.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,853.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,339.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,994.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,282.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE W/PLASTER VEST
|
Facility
|
OP
|
$5,706.00
|
|
|
Service Code
|
CPT L0820
|
| Hospital Charge Code |
905350820
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,868.71 |
| Max. Negotiated Rate |
$5,135.40 |
| Rate for Payer: Adventist Health Commercial |
$2,339.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,138.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,279.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,351.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,410.74
|
| Rate for Payer: Blue Shield of California EPN |
$2,875.82
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Cash Price |
$2,567.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,564.80
|
| Rate for Payer: Cigna of CA HMO |
$3,994.20
|
| Rate for Payer: Cigna of CA PPO |
$3,994.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,850.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,850.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,282.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,282.40
|
| Rate for Payer: Galaxy Health WC |
$4,850.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,423.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,135.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,908.03
|
| Rate for Payer: InnovAge PACE Commercial |
$2,853.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,805.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,107.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,532.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,339.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,994.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,994.20
|
| Rate for Payer: Multiplan Commercial |
$4,279.50
|
| Rate for Payer: Networks By Design Commercial |
$2,853.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,850.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,282.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,423.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,141.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,084.40
|
| Rate for Payer: United Healthcare HMO Rider |
$2,039.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,868.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,850.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,850.10
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,201.11 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,571.89
|
| Rate for Payer: Blue Shield of California Commercial |
$8,649.87
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,201.11
|
| Rate for Payer: InnovAge PACE Commercial |
$5,595.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,587.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,833.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,649.87
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,263.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$7,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$2,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,649.87
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,263.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$7,273.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
915350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,201.11 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Adventist Health Commercial |
$4,587.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,392.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,571.89
|
| Rate for Payer: Blue Shield of California Commercial |
$8,649.87
|
| Rate for Payer: Blue Shield of California EPN |
$5,639.76
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,201.11
|
| Rate for Payer: InnovAge PACE Commercial |
$5,595.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,536.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,926.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,587.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,833.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,833.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,199.61
|
| Rate for Payer: United Healthcare All Other HMO |
$4,087.71
|
| Rate for Payer: United Healthcare HMO Rider |
$3,999.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,664.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.09
|
| Rate for Payer: Blue Shield of California Commercial |
$262.05
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.04
|
| Rate for Payer: InnovAge PACE Commercial |
$169.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health System MISP |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$262.05
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
915350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$111.02 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$138.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$254.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.09
|
| Rate for Payer: Blue Shield of California Commercial |
$262.05
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$233.04
|
| Rate for Payer: InnovAge PACE Commercial |
$169.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$237.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$237.30
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health System MISP |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Adventist Health Commercial |
$67.80
|
| Rate for Payer: Blue Shield of California Commercial |
$262.05
|
| Rate for Payer: Blue Shield of California EPN |
$170.86
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Senior |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$209.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$220.35
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.23
|
| Rate for Payer: United Healthcare All Other HMO |
$123.84
|
| Rate for Payer: United Healthcare HMO Rider |
$121.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.02
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
IP
|
$990.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Adventist Health Commercial |
$198.00
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$792.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.00
|
| Rate for Payer: EPIC Health Plan Senior |
$396.00
|
| Rate for Payer: Galaxy Health WC |
$841.50
|
| Rate for Payer: Global Benefits Group Commercial |
$594.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$660.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$612.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$742.50
|
| Rate for Payer: Networks By Design Commercial |
$643.50
|
| Rate for Payer: Prime Health Services Commercial |
$841.50
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
OP
|
$990.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$198.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$633.60
|
| Rate for Payer: Cigna of CA PPO |
$732.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$841.50
|
| Rate for Payer: Global Benefits Group Commercial |
$594.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$660.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$742.50
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$643.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.02
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$841.50
|
| Rate for Payer: Prime Health Services Medicare |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$594.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.00
|
| Rate for Payer: United Healthcare All Other HMO |
$495.00
|
| Rate for Payer: United Healthcare HMO Rider |
$495.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$495.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$1,079.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$971.10 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$655.28
|
| 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 |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.40
|
| Rate for Payer: Blue Shield of California Commercial |
$654.95
|
| Rate for Payer: Blue Shield of California EPN |
$428.36
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Central Health Plan Commercial |
$863.20
|
| Rate for Payer: Cigna of CA HMO |
$690.56
|
| Rate for Payer: Cigna of CA PPO |
$798.46
|
| 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 |
$917.15
|
| Rate for Payer: Global Benefits Group Commercial |
$647.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$971.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.24
|
| 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 |
$719.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.80
|
| 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 |
$809.25
|
| Rate for Payer: Networks By Design Commercial |
$701.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$917.15
|
| 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 |
$647.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$647.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: 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 HAND COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$1,079.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$215.80 |
| Max. Negotiated Rate |
$971.10 |
| Rate for Payer: Adventist Health Commercial |
$215.80
|
| Rate for Payer: Cash Price |
$485.55
|
| Rate for Payer: Central Health Plan Commercial |
$863.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$431.60
|
| Rate for Payer: EPIC Health Plan Senior |
$431.60
|
| Rate for Payer: Galaxy Health WC |
$917.15
|
| Rate for Payer: Global Benefits Group Commercial |
$647.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$971.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$719.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$411.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$667.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.80
|
| Rate for Payer: Multiplan Commercial |
$809.25
|
| Rate for Payer: Networks By Design Commercial |
$701.35
|
| Rate for Payer: Prime Health Services Commercial |
$917.15
|
|
|
HC HAND LIMITED 2 VIEWS
|
Facility
|
OP
|
$1,076.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.83 |
| Max. Negotiated Rate |
$968.40 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$653.45
|
| 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 |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.83
|
| Rate for Payer: Blue Shield of California Commercial |
$653.13
|
| Rate for Payer: Blue Shield of California EPN |
$427.17
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Central Health Plan Commercial |
$860.80
|
| Rate for Payer: Cigna of CA HMO |
$688.64
|
| Rate for Payer: Cigna of CA PPO |
$796.24
|
| 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 |
$914.60
|
| Rate for Payer: Global Benefits Group Commercial |
$645.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$968.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.76
|
| 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 |
$717.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.20
|
| 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 |
$807.00
|
| Rate for Payer: Networks By Design Commercial |
$699.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$914.60
|
| 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 |
$645.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$645.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: 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 HAND LIMITED 2 VIEWS
|
Facility
|
IP
|
$1,076.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$215.20 |
| Max. Negotiated Rate |
$968.40 |
| Rate for Payer: Adventist Health Commercial |
$215.20
|
| Rate for Payer: Cash Price |
$484.20
|
| Rate for Payer: Central Health Plan Commercial |
$860.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.40
|
| Rate for Payer: EPIC Health Plan Senior |
$430.40
|
| Rate for Payer: Galaxy Health WC |
$914.60
|
| Rate for Payer: Global Benefits Group Commercial |
$645.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$968.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$666.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.20
|
| Rate for Payer: Multiplan Commercial |
$807.00
|
| Rate for Payer: Networks By Design Commercial |
$699.40
|
| Rate for Payer: Prime Health Services Commercial |
$914.60
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$116.59 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$125.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.50
|
| 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 |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$195.84
|
| Rate for Payer: Cigna of CA PPO |
$226.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: InnovAge PACE Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$214.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
| Rate for Payer: Riverside University Health System MISP |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.60
|
| 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 |
$260.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.10
|
| Rate for Payer: Vantage Medical Group Senior |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
901300025
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900400010
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.59 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$125.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.50
|
| 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 |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$195.84
|
| Rate for Payer: Cigna of CA PPO |
$226.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: InnovAge PACE Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$214.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
| Rate for Payer: Riverside University Health System MISP |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.60
|
| 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 |
$260.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.10
|
| Rate for Payer: Vantage Medical Group Senior |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900419058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.59 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$125.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.50
|
| 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 |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$195.84
|
| Rate for Payer: Cigna of CA PPO |
$226.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: InnovAge PACE Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$214.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
| Rate for Payer: Riverside University Health System MISP |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.60
|
| 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 |
$260.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.10
|
| Rate for Payer: Vantage Medical Group Senior |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
900419058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905103403
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$116.59 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$125.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$185.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$260.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.50
|
| 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 |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: Cigna of CA HMO |
$195.84
|
| Rate for Payer: Cigna of CA PPO |
$226.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$260.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$260.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: InnovAge PACE Commercial |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$214.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$214.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
| Rate for Payer: Riverside University Health System MISP |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.60
|
| 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 |
$260.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$260.10
|
| Rate for Payer: Vantage Medical Group Senior |
$260.10
|
|
|
HC HAND MUSCLE TESTING MANUAL PT
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905103403
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$275.40 |
| Rate for Payer: Adventist Health Commercial |
$61.20
|
| Rate for Payer: Cash Price |
$137.70
|
| Rate for Payer: Central Health Plan Commercial |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.40
|
| Rate for Payer: EPIC Health Plan Senior |
$122.40
|
| Rate for Payer: Galaxy Health WC |
$260.10
|
| Rate for Payer: Global Benefits Group Commercial |
$183.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$275.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$204.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$189.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.20
|
| Rate for Payer: Multiplan Commercial |
$229.50
|
| Rate for Payer: Networks By Design Commercial |
$198.90
|
| Rate for Payer: Prime Health Services Commercial |
$260.10
|
|
|
HC HAND WRIST BOTH 1 VIEW
|
Facility
|
IP
|
$1,614.00
|
|
|
Service Code
|
CPT 73120 50
|
| Hospital Charge Code |
909073120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$1,452.60 |
| Rate for Payer: Adventist Health Commercial |
$322.80
|
| Rate for Payer: Cash Price |
$726.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.60
|
| Rate for Payer: EPIC Health Plan Senior |
$645.60
|
| Rate for Payer: Galaxy Health WC |
$1,371.90
|
| Rate for Payer: Global Benefits Group Commercial |
$968.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,452.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,076.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$614.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$999.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.80
|
| Rate for Payer: Multiplan Commercial |
$1,210.50
|
| Rate for Payer: Networks By Design Commercial |
$1,049.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.90
|
|
