|
HC DVC PELVIC ORTHOTIC TPOD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901605152
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$120.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$364.82
|
| Rate for Payer: Blue Shield of California EPN |
$283.62
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DVC RESQPOD RESUSCITATOR
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901605270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.66
|
| Rate for Payer: Blue Distinction Transplant |
$348.00
|
| Rate for Payer: Blue Shield of California Commercial |
$364.82
|
| Rate for Payer: Blue Shield of California EPN |
$283.62
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Media |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$435.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Riverside University Health System MISP |
$232.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC DVC RESQPOD RESUSCITATOR
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901605270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC DVC THORACENTESIS 8FR
|
Facility
|
OP
|
$296.10
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901600672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.93
|
| Rate for Payer: Blue Distinction Transplant |
$177.66
|
| Rate for Payer: Blue Shield of California Commercial |
$222.08
|
| Rate for Payer: Blue Shield of California EPN |
$161.08
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Central Health Plan Commercial |
$236.88
|
| Rate for Payer: Cigna of CA HMO |
$207.27
|
| Rate for Payer: Cigna of CA PPO |
$207.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.68
|
| Rate for Payer: Dignity Health Media |
$251.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$118.44
|
| Rate for Payer: Galaxy Health WC |
$251.68
|
| Rate for Payer: Global Benefits Group Commercial |
$177.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$222.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.22
|
| Rate for Payer: Multiplan Commercial |
$222.08
|
| Rate for Payer: Networks By Design Commercial |
$148.05
|
| Rate for Payer: Prime Health Services Commercial |
$251.68
|
| Rate for Payer: Riverside University Health System MISP |
$118.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.05
|
| Rate for Payer: United Healthcare All Other HMO |
$148.05
|
| Rate for Payer: United Healthcare HMO Rider |
$148.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.68
|
| Rate for Payer: Vantage Medical Group Senior |
$251.68
|
|
|
HC DVC THORACENTESIS 8FR
|
Facility
|
IP
|
$296.10
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901600672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$59.22 |
| Max. Negotiated Rate |
$266.49 |
| Rate for Payer: Blue Shield of California EPN |
$158.12
|
| Rate for Payer: Cash Price |
$133.25
|
| Rate for Payer: Central Health Plan Commercial |
$236.88
|
| Rate for Payer: Cigna of CA HMO |
$207.27
|
| Rate for Payer: Cigna of CA PPO |
$207.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$118.44
|
| Rate for Payer: Galaxy Health WC |
$251.68
|
| Rate for Payer: Global Benefits Group Commercial |
$177.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.22
|
| Rate for Payer: Multiplan Commercial |
$222.08
|
| Rate for Payer: Prime Health Services Commercial |
$251.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.81
|
| Rate for Payer: United Healthcare All Other HMO |
$109.20
|
| Rate for Payer: United Healthcare HMO Rider |
$106.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.71
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$227.60 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Central Health Plan Commercial |
$910.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.20
|
| Rate for Payer: Galaxy Health WC |
$967.30
|
| Rate for Payer: Global Benefits Group Commercial |
$682.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,024.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.60
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
| Rate for Payer: Networks By Design Commercial |
$739.70
|
| Rate for Payer: Prime Health Services Commercial |
$967.30
|
|
|
HC DVLP TEST PHYS/QHP PT 1ST HR
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
900400020
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$682.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Central Health Plan Commercial |
$910.40
|
| Rate for Payer: Cigna of CA HMO |
$728.32
|
| Rate for Payer: Cigna of CA PPO |
$842.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$967.30
|
| Rate for Payer: Global Benefits Group Commercial |
$682.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,024.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$853.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
| Rate for Payer: Networks By Design Commercial |
$739.70
|
| Rate for Payer: Prime Health Services Commercial |
$967.30
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$227.60 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Central Health Plan Commercial |
$910.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.20
|
| Rate for Payer: Galaxy Health WC |
$967.30
|
| Rate for Payer: Global Benefits Group Commercial |
$682.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,024.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.60
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
| Rate for Payer: Networks By Design Commercial |
$739.70
|
| Rate for Payer: Prime Health Services Commercial |
$967.30
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$195.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$682.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$195.17
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Central Health Plan Commercial |
$910.40
|
| Rate for Payer: Cigna of CA HMO |
$728.32
|
| Rate for Payer: Cigna of CA PPO |
$842.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$967.30
|
| Rate for Payer: Global Benefits Group Commercial |
$682.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,024.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$853.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$322.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: InnovAge PACE Commercial |
$292.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$466.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
| Rate for Payer: Networks By Design Commercial |
$739.70
|
| Rate for Payer: Prime Health Services Commercial |
$967.30
|
| Rate for Payer: Prime Health Services Medicare |
$206.88
|
| Rate for Payer: Riverside University Health System MISP |
$214.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC DXA BONE DENSITY APPENDICULAR
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
900377081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.69 |
| Max. Negotiated Rate |
$385.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$315.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.20
|
| Rate for Payer: Blue Distinction Transplant |
$178.80
|
| Rate for Payer: Blue Shield of California Commercial |
$184.16
|
| Rate for Payer: Blue Shield of California EPN |
$144.83
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$223.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.21
|
| Rate for Payer: United Healthcare All Other HMO |
$82.21
|
| Rate for Payer: United Healthcare HMO Rider |
$82.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC DXA BONE DENSITY APPENDICULAR
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 77081
|
| Hospital Charge Code |
900377081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC DXA BONE DENSITY AXIAL
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
900377080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$431.10 |
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Central Health Plan Commercial |
$383.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.60
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.80
|
| Rate for Payer: Multiplan Commercial |
$359.25
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
|
|
HC DXA BONE DENSITY AXIAL
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 77080
|
| Hospital Charge Code |
900377080
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.11 |
| Max. Negotiated Rate |
$724.65 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$474.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$594.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$724.65
|
| Rate for Payer: Blue Distinction Transplant |
$287.40
|
| Rate for Payer: Blue Shield of California Commercial |
$296.02
|
| Rate for Payer: Blue Shield of California EPN |
$232.79
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Central Health Plan Commercial |
$383.20
|
| Rate for Payer: Cigna of CA HMO |
$306.56
|
| Rate for Payer: Cigna of CA PPO |
$354.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$431.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$359.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$359.25
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$182.99
|
| Rate for Payer: United Healthcare All Other HMO |
$182.99
|
| Rate for Payer: United Healthcare HMO Rider |
$182.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DXA BONE DNSTY AXIAL W FX EVAL
|
Facility
|
IP
|
$549.00
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
900377085
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.80 |
| Max. Negotiated Rate |
$494.10 |
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Central Health Plan Commercial |
$439.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$219.60
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$494.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.80
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
| Rate for Payer: Networks By Design Commercial |
$356.85
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
|
|
HC DXA BONE DNSTY AXIAL W FX EVAL
|
Facility
|
OP
|
$549.00
|
|
|
Service Code
|
CPT 77085
|
| Hospital Charge Code |
900377085
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.49 |
| Max. Negotiated Rate |
$526.79 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$431.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.79
|
| Rate for Payer: Blue Distinction Transplant |
$329.40
|
| Rate for Payer: Blue Shield of California Commercial |
$339.28
|
| Rate for Payer: Blue Shield of California EPN |
$266.81
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Cash Price |
$247.05
|
| Rate for Payer: Central Health Plan Commercial |
$439.20
|
| Rate for Payer: Cigna of CA HMO |
$351.36
|
| Rate for Payer: Cigna of CA PPO |
$406.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$466.65
|
| Rate for Payer: Global Benefits Group Commercial |
$329.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$494.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$411.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$366.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$411.75
|
| Rate for Payer: Networks By Design Commercial |
$356.85
|
| Rate for Payer: Prime Health Services Commercial |
$466.65
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$329.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$329.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$243.15
|
| Rate for Payer: United Healthcare All Other HMO |
$243.15
|
| Rate for Payer: United Healthcare HMO Rider |
$243.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$243.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC DXA FX ASSESSMENT
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 77086
|
| Hospital Charge Code |
900377086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.80
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
|
|
HC DXA FX ASSESSMENT
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 77086
|
| Hospital Charge Code |
900377086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$342.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.73
|
| Rate for Payer: Blue Distinction Transplant |
$164.40
|
| Rate for Payer: Blue Shield of California Commercial |
$169.33
|
| Rate for Payer: Blue Shield of California EPN |
$133.16
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$205.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.90
|
| Rate for Payer: United Healthcare All Other HMO |
$151.90
|
| Rate for Payer: United Healthcare HMO Rider |
$151.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$151.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC DYNAMIC FLEXOR HINGE,RECIPROCA
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
903203901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.75 |
| Max. Negotiated Rate |
$1,549.41 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$147.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.19
|
| Rate for Payer: Blue Distinction Transplant |
$183.00
|
| Rate for Payer: Blue Shield of California Commercial |
$228.75
|
| Rate for Payer: Blue Shield of California EPN |
$165.92
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.25
|
| Rate for Payer: Dignity Health Media |
$259.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$259.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,549.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.05
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: Riverside University Health System MISP |
$122.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$183.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$183.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$152.50
|
| Rate for Payer: United Healthcare All Other HMO |
$152.50
|
| Rate for Payer: United Healthcare HMO Rider |
$152.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$152.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$259.25
|
| Rate for Payer: Vantage Medical Group Senior |
$259.25
|
|
|
HC DYNAMIC FLEXOR HINGE,RECIPROCA
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT L3901
|
| Hospital Charge Code |
903203901
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.00 |
| Max. Negotiated Rate |
$274.50 |
| Rate for Payer: Blue Shield of California EPN |
$162.87
|
| Rate for Payer: Cash Price |
$137.25
|
| Rate for Payer: Central Health Plan Commercial |
$244.00
|
| Rate for Payer: Cigna of CA HMO |
$213.50
|
| Rate for Payer: Cigna of CA PPO |
$213.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$122.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$122.00
|
| Rate for Payer: Galaxy Health WC |
$259.25
|
| Rate for Payer: Global Benefits Group Commercial |
$183.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$274.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$203.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.00
|
| Rate for Payer: Multiplan Commercial |
$228.75
|
| Rate for Payer: Networks By Design Commercial |
$152.50
|
| Rate for Payer: Prime Health Services Commercial |
$259.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.17
|
| Rate for Payer: United Healthcare All Other HMO |
$112.48
|
| Rate for Payer: United Healthcare HMO Rider |
$110.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$100.65
|
|
|
HC DYNAMIC FLEXOR HINGE,WRIST/FIN
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
903203900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$149.45 |
| Max. Negotiated Rate |
$1,163.86 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$206.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.27
|
| Rate for Payer: Blue Distinction Transplant |
$256.20
|
| Rate for Payer: Blue Shield of California Commercial |
$320.25
|
| Rate for Payer: Blue Shield of California EPN |
$232.29
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.95
|
| Rate for Payer: Dignity Health Media |
$362.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$320.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,163.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.07
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$213.50
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: Riverside University Health System MISP |
$170.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.50
|
| Rate for Payer: United Healthcare All Other HMO |
$213.50
|
| Rate for Payer: United Healthcare HMO Rider |
$213.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.95
|
| Rate for Payer: Vantage Medical Group Senior |
$362.95
|
|
|
HC DYNAMIC FLEXOR HINGE,WRIST/FIN
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT L3900
|
| Hospital Charge Code |
903203900
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Blue Shield of California EPN |
$228.02
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Cigna of CA HMO |
$298.90
|
| Rate for Payer: Cigna of CA PPO |
$298.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$213.50
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.24
|
| Rate for Payer: United Healthcare All Other HMO |
$157.48
|
| Rate for Payer: United Healthcare HMO Rider |
$154.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.91
|
|
|
HC DYNAMIC PLYON
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
905355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Blue Shield of California EPN |
$269.67
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$190.69
|
| Rate for Payer: United Healthcare All Other HMO |
$186.24
|
| Rate for Payer: United Healthcare HMO Rider |
$182.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.65
|
|
|
HC DYNAMIC PLYON
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
905355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.75 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$244.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.35
|
| Rate for Payer: Blue Distinction Transplant |
$303.00
|
| Rate for Payer: Blue Shield of California Commercial |
$378.75
|
| Rate for Payer: Blue Shield of California EPN |
$274.72
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Media |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$378.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.05
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Riverside University Health System MISP |
$202.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.50
|
| Rate for Payer: United Healthcare All Other HMO |
$252.50
|
| Rate for Payer: United Healthcare HMO Rider |
$252.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
IP
|
$792.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$712.80 |
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$528.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
OP
|
$792.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$158.40 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$475.20
|
| Rate for Payer: Blue Shield of California Commercial |
$489.46
|
| Rate for Payer: Blue Shield of California EPN |
$384.91
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Central Health Plan Commercial |
$633.60
|
| Rate for Payer: Cigna of CA HMO |
$506.88
|
| Rate for Payer: Cigna of CA PPO |
$586.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.20
|
| Rate for Payer: Dignity Health Media |
$673.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$673.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$316.80
|
| Rate for Payer: Galaxy Health WC |
$673.20
|
| Rate for Payer: Global Benefits Group Commercial |
$475.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$712.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$594.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$277.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$528.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$287.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$594.00
|
| Rate for Payer: Networks By Design Commercial |
$514.80
|
| Rate for Payer: Prime Health Services Commercial |
$673.20
|
| Rate for Payer: Riverside University Health System MISP |
$316.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$475.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$475.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$396.00
|
| Rate for Payer: United Healthcare HMO Rider |
$396.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$396.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$673.20
|
| Rate for Payer: Vantage Medical Group Senior |
$673.20
|
|
