|
HC FRACTIONAL O2 SATUR (BG POC)
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 82810
|
| Hospital Charge Code |
900912230
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC FREE T4 BY EIA
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$79.99 |
| Rate for Payer: Adventist Health Medi-Cal |
$9.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.99
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$9.02
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.53
|
| Rate for Payer: Dignity Health Media |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.02
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: InnovAge PACE Commercial |
$13.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.09
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$9.56
|
| Rate for Payer: Riverside University Health System MISP |
$9.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
|
|
HC FREE T4 BY EIA
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC FRICTION ARM SUPPORT
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT L3968
|
| Hospital Charge Code |
903203968
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$343.80 |
| Max. Negotiated Rate |
$1,547.10 |
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.60
|
| Rate for Payer: Galaxy Health WC |
$1,461.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,031.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,547.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,146.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.80
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: Networks By Design Commercial |
$1,117.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,461.15
|
|
|
HC FRICTION ARM SUPPORT
|
Facility
|
OP
|
$1,719.00
|
|
|
Service Code
|
CPT L3968
|
| Hospital Charge Code |
903203968
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$343.80 |
| Max. Negotiated Rate |
$1,547.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,043.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,461.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$945.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$945.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$832.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,015.59
|
| Rate for Payer: Blue Distinction Transplant |
$1,031.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,081.25
|
| Rate for Payer: Blue Shield of California EPN |
$840.59
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,375.20
|
| Rate for Payer: Cigna of CA HMO |
$1,100.16
|
| Rate for Payer: Cigna of CA PPO |
$1,272.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,461.15
|
| Rate for Payer: Dignity Health Media |
$1,461.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,461.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.60
|
| Rate for Payer: Galaxy Health WC |
$1,461.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,031.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,547.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,289.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$601.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,146.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.80
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: Networks By Design Commercial |
$1,117.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,461.15
|
| Rate for Payer: Riverside University Health System MISP |
$687.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,031.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,031.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$859.50
|
| Rate for Payer: United Healthcare All Other HMO |
$859.50
|
| Rate for Payer: United Healthcare HMO Rider |
$859.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$859.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,461.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,461.15
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.00
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$352.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$213.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$178.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.29
|
| Rate for Payer: Blue Distinction Transplant |
$89.40
|
| Rate for Payer: Blue Shield of California Commercial |
$92.08
|
| Rate for Payer: Blue Shield of California EPN |
$72.41
|
| Rate for Payer: Caremore Medicare Advantage |
$213.41
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Central Health Plan Commercial |
$119.20
|
| Rate for Payer: Cigna of CA HMO |
$95.36
|
| Rate for Payer: Cigna of CA PPO |
$110.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$349.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$352.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: InnovAge PACE Commercial |
$320.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$111.75
|
| Rate for Payer: Networks By Design Commercial |
$96.85
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Prime Health Services Medicare |
$226.21
|
| Rate for Payer: Riverside University Health System MISP |
$234.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC FSH
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$164.88 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.88
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$22.25
|
| Rate for Payer: Blue Shield of California EPN |
$17.50
|
| Rate for Payer: Caremore Medicare Advantage |
$18.58
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.87
|
| Rate for Payer: Dignity Health Media |
$18.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.58
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.58
|
| Rate for Payer: InnovAge PACE Commercial |
$27.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.90
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Medicare |
$19.69
|
| Rate for Payer: Riverside University Health System MISP |
$20.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO |
$15.05
|
| Rate for Payer: United Healthcare HMO Rider |
$15.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.58
|
|
|
HC FSH
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
OP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,548.83 |
| Max. Negotiated Rate |
$7,128.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,356.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,356.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,834.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,679.14
|
| Rate for Payer: Blue Distinction Transplant |
$4,752.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,940.00
|
| Rate for Payer: Blue Shield of California EPN |
$4,308.48
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,336.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,732.00
|
| Rate for Payer: Dignity Health Media |
$6,732.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,732.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,128.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,940.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,772.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,548.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,247.20
|
| Rate for Payer: Multiplan Commercial |
$5,940.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: Riverside University Health System MISP |
$3,168.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,752.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,752.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,960.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,960.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,960.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,960.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,732.00
|
| Rate for Payer: Vantage Medical Group Senior |
$6,732.00
|
|
|
HC FT MULTIAXIAL ANKL/FT DYN RESP
|
Facility
|
IP
|
$7,920.00
|
|
|
Service Code
|
CPT L5979
|
| Hospital Charge Code |
905355979
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,584.00 |
| Max. Negotiated Rate |
$7,128.00 |
| Rate for Payer: Blue Shield of California EPN |
$4,229.28
|
| Rate for Payer: Cash Price |
$3,564.00
|
| Rate for Payer: Central Health Plan Commercial |
$6,336.00
|
| Rate for Payer: Cigna of CA HMO |
$5,544.00
|
| Rate for Payer: Cigna of CA PPO |
$5,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,168.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,168.00
|
| Rate for Payer: Galaxy Health WC |
$6,732.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,752.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,128.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,282.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,017.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,584.00
|
| Rate for Payer: Multiplan Commercial |
$5,940.00
|
| Rate for Payer: Networks By Design Commercial |
$3,960.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,990.59
|
| Rate for Payer: United Healthcare All Other HMO |
$2,920.90
|
| Rate for Payer: United Healthcare HMO Rider |
$2,857.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,613.60
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.98 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.99
|
| Rate for Payer: Blue Distinction Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$82.50
|
| Rate for Payer: Blue Shield of California EPN |
$59.84
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Media |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.10
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Riverside University Health System MISP |
$44.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.00
|
| Rate for Payer: United Healthcare All Other HMO |
$55.00
|
| Rate for Payer: United Healthcare HMO Rider |
$55.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC FULL SOLE & HEEL WEDGE BETWEEN
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L3420
|
| Hospital Charge Code |
905353420
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Blue Shield of California EPN |
$58.74
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.54
|
| Rate for Payer: United Healthcare All Other HMO |
$40.57
|
| Rate for Payer: United Healthcare HMO Rider |
$39.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.30
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
IP
|
$5,782.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,156.40 |
| Max. Negotiated Rate |
$5,203.80 |
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,625.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,312.80
|
| Rate for Payer: Galaxy Health WC |
$4,914.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,203.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,856.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,202.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.40
|
| Rate for Payer: Multiplan Commercial |
$4,336.50
|
| Rate for Payer: Networks By Design Commercial |
$3,758.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,914.70
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
OP
|
$5,782.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,469.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,625.60
|
| Rate for Payer: Cigna of CA PPO |
$4,278.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,914.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,203.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,336.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,856.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,156.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$4,336.50
|
| Rate for Payer: Networks By Design Commercial |
$3,758.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,914.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,469.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,891.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,891.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,891.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,891.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
IP
|
$6,883.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,376.60 |
| Max. Negotiated Rate |
$6,194.70 |
| Rate for Payer: Cash Price |
$3,097.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,506.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,753.20
|
| Rate for Payer: Galaxy Health WC |
$5,850.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,129.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,194.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,622.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,376.60
|
| Rate for Payer: Multiplan Commercial |
$5,162.25
|
| Rate for Payer: Networks By Design Commercial |
$4,473.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,850.55
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
OP
|
$6,883.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,129.80
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$3,097.35
|
| Rate for Payer: Cash Price |
$3,097.35
|
| Rate for Payer: Cash Price |
$3,097.35
|
| Rate for Payer: Cash Price |
$3,097.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,506.40
|
| Rate for Payer: Cigna of CA PPO |
$5,093.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$5,850.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,129.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,194.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,162.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,590.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,376.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$5,162.25
|
| Rate for Payer: Networks By Design Commercial |
$4,473.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,850.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,129.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,441.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,441.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,441.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,441.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
IP
|
$5,982.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,196.40 |
| Max. Negotiated Rate |
$5,383.80 |
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,785.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,392.80
|
| Rate for Payer: Galaxy Health WC |
$5,084.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,589.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,383.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,989.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,279.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.40
|
| Rate for Payer: Multiplan Commercial |
$4,486.50
|
| Rate for Payer: Networks By Design Commercial |
$3,888.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,084.70
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
OP
|
$5,982.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,589.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: Cash Price |
$2,691.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,785.60
|
| Rate for Payer: Cigna of CA PPO |
$4,426.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$5,084.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,589.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,383.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,486.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,989.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$4,486.50
|
| Rate for Payer: Networks By Design Commercial |
$3,888.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,084.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,589.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,991.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,991.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,991.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,991.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC FUNCTIONAL CAPACITY MEASURE OT
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 97670
|
| Hospital Charge Code |
903207670
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$865.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,211.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$783.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$783.75
|
| 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 |
$855.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,140.00
|
| Rate for Payer: Cigna of CA HMO |
$912.00
|
| Rate for Payer: Cigna of CA PPO |
$1,054.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,211.25
|
| Rate for Payer: Dignity Health Media |
$1,211.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,211.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$570.00
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,282.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,068.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$498.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
| Rate for Payer: Riverside University Health System MISP |
$570.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$855.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$855.00
|
| 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 Medi-Cal |
$1,211.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,211.25
|
|
|
HC FUNCTIONAL CAPACITY MEASURE OT
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 97670
|
| Hospital Charge Code |
903207670
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$285.00 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$570.00
|
| Rate for Payer: Galaxy Health WC |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,282.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$542.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.00
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
|
|
HC FUNCTIONAL CAPACITY MEASURE PT
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
903200165
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.85 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.40
|
| 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 |
$136.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Central Health Plan Commercial |
$182.40
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Media |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$171.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.48
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Riverside University Health System MISP |
$91.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| 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 Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC FUNCTIONAL CAPACITY MEASURE PT
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 97750
|
| Hospital Charge Code |
903200165
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Central Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$205.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$152.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$171.00
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
OP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$29,060.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,060.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,590.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,590.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,801.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,078.97
|
| Rate for Payer: Blue Distinction Transplant |
$7,189.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,536.68
|
| Rate for Payer: Blue Shield of California EPN |
$5,859.20
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,585.60
|
| Rate for Payer: Cigna of CA HMO |
$7,668.48
|
| Rate for Payer: Cigna of CA PPO |
$8,866.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Dignity Health Media |
$10,184.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,184.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,783.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,986.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,193.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.40
|
| Rate for Payer: Multiplan Commercial |
$8,986.50
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,792.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,189.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,189.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,991.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,991.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,991.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,991.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10,184.70
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
IP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,396.40 |
| Max. Negotiated Rate |
$10,783.80 |
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,585.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,783.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,396.40
|
| Rate for Payer: Multiplan Commercial |
$8,986.50
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
|
