|
HC GUIDEWIRE SYNCHRO
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909000003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$396.30 |
| Max. Negotiated Rate |
$2,610.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,595.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,595.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,404.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,713.91
|
| Rate for Payer: Blue Distinction Transplant |
$1,740.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,824.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,418.59
|
| Rate for Payer: Cash Price |
$1,305.45
|
| Rate for Payer: Cash Price |
$1,305.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,320.80
|
| Rate for Payer: Cigna of CA HMO |
$1,856.64
|
| Rate for Payer: Cigna of CA PPO |
$2,146.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,465.85
|
| Rate for Payer: Dignity Health Media |
$2,465.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,465.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,160.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,160.40
|
| Rate for Payer: Galaxy Health WC |
$2,465.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,740.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,610.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,175.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,015.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,934.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,105.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$580.20
|
| Rate for Payer: Multiplan Commercial |
$2,175.75
|
| Rate for Payer: Networks By Design Commercial |
$1,885.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,465.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,740.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,740.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,450.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,450.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,450.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,450.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,465.85
|
| Rate for Payer: Vantage Medical Group Senior |
$2,465.85
|
|
|
HC GUIDEWIRE, TRANSEND
|
Facility
|
OP
|
$1,108.60
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.72 |
| Max. Negotiated Rate |
$997.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$942.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$609.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$609.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$536.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$654.96
|
| Rate for Payer: Blue Distinction Transplant |
$665.16
|
| Rate for Payer: Blue Shield of California Commercial |
$697.31
|
| Rate for Payer: Blue Shield of California EPN |
$542.11
|
| Rate for Payer: Cash Price |
$498.87
|
| Rate for Payer: Cash Price |
$498.87
|
| Rate for Payer: Central Health Plan Commercial |
$886.88
|
| Rate for Payer: Cigna of CA HMO |
$709.50
|
| Rate for Payer: Cigna of CA PPO |
$820.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$942.31
|
| Rate for Payer: Dignity Health Media |
$942.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$942.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$443.44
|
| Rate for Payer: Galaxy Health WC |
$942.31
|
| Rate for Payer: Global Benefits Group Commercial |
$665.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$997.74
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$831.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$388.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.72
|
| Rate for Payer: Multiplan Commercial |
$831.45
|
| Rate for Payer: Networks By Design Commercial |
$720.59
|
| Rate for Payer: Prime Health Services Commercial |
$942.31
|
| Rate for Payer: Riverside University Health System MISP |
$443.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$665.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$665.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$554.30
|
| Rate for Payer: United Healthcare All Other HMO |
$554.30
|
| Rate for Payer: United Healthcare HMO Rider |
$554.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$554.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$942.31
|
| Rate for Payer: Vantage Medical Group Senior |
$942.31
|
|
|
HC GUIDEWIRE, TRANSEND
|
Facility
|
IP
|
$1,108.60
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909020096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$221.72 |
| Max. Negotiated Rate |
$997.74 |
| Rate for Payer: Cash Price |
$498.87
|
| Rate for Payer: Central Health Plan Commercial |
$886.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$443.44
|
| Rate for Payer: Galaxy Health WC |
$942.31
|
| Rate for Payer: Global Benefits Group Commercial |
$665.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$997.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$739.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.72
|
| Rate for Payer: Multiplan Commercial |
$831.45
|
| Rate for Payer: Networks By Design Commercial |
$720.59
|
| Rate for Payer: Prime Health Services Commercial |
$942.31
|
|
|
HC GUIDEWIRE VASC T-J FXD CORE
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC GUIDEWIRE VASC T-J FXD CORE
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC GUIDEWR, .015",20CM STRT FLXBL
|
Facility
|
IP
|
$149.87
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.97 |
| Max. Negotiated Rate |
$134.88 |
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Central Health Plan Commercial |
$119.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.95
|
| Rate for Payer: Galaxy Health WC |
$127.39
|
| Rate for Payer: Global Benefits Group Commercial |
$89.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Multiplan Commercial |
$112.40
|
| Rate for Payer: Networks By Design Commercial |
$97.42
|
| Rate for Payer: Prime Health Services Commercial |
$127.39
|
|
|
HC GUIDEWR, .015",20CM STRT FLXBL
|
Facility
|
OP
|
$149.87
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.97 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.54
|
| Rate for Payer: Blue Distinction Transplant |
$89.92
|
| Rate for Payer: Blue Shield of California Commercial |
$94.27
|
| Rate for Payer: Blue Shield of California EPN |
$73.29
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Cash Price |
$67.44
|
| Rate for Payer: Central Health Plan Commercial |
$119.90
|
| Rate for Payer: Cigna of CA HMO |
$95.92
|
| Rate for Payer: Cigna of CA PPO |
$110.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.39
|
| Rate for Payer: Dignity Health Media |
$127.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.95
|
| Rate for Payer: Galaxy Health WC |
$127.39
|
| Rate for Payer: Global Benefits Group Commercial |
$89.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$112.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.97
|
| Rate for Payer: Multiplan Commercial |
$112.40
|
| Rate for Payer: Networks By Design Commercial |
$97.42
|
| Rate for Payer: Prime Health Services Commercial |
$127.39
|
| Rate for Payer: Riverside University Health System MISP |
$59.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.94
|
| Rate for Payer: United Healthcare All Other HMO |
$74.94
|
| Rate for Payer: United Healthcare HMO Rider |
$74.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.39
|
| Rate for Payer: Vantage Medical Group Senior |
$127.39
|
|
|
HC GUIDEWR,STRT CURVED .025"X50CM
|
Facility
|
IP
|
$222.88
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$200.59 |
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Central Health Plan Commercial |
$178.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.15
|
| Rate for Payer: Galaxy Health WC |
$189.45
|
| Rate for Payer: Global Benefits Group Commercial |
$133.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.58
|
| Rate for Payer: Multiplan Commercial |
$167.16
|
| Rate for Payer: Networks By Design Commercial |
$144.87
|
| Rate for Payer: Prime Health Services Commercial |
$189.45
|
|
|
HC GUIDEWR,STRT CURVED .025"X50CM
|
Facility
|
OP
|
$222.88
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.58 |
| Max. Negotiated Rate |
$396.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$189.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$131.68
|
| Rate for Payer: Blue Distinction Transplant |
$133.73
|
| Rate for Payer: Blue Shield of California Commercial |
$140.19
|
| Rate for Payer: Blue Shield of California EPN |
$108.99
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Cash Price |
$100.30
|
| Rate for Payer: Central Health Plan Commercial |
$178.30
|
| Rate for Payer: Cigna of CA HMO |
$142.64
|
| Rate for Payer: Cigna of CA PPO |
$164.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$189.45
|
| Rate for Payer: Dignity Health Media |
$189.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$189.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$89.15
|
| Rate for Payer: Galaxy Health WC |
$189.45
|
| Rate for Payer: Global Benefits Group Commercial |
$133.73
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$167.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.58
|
| Rate for Payer: Multiplan Commercial |
$167.16
|
| Rate for Payer: Networks By Design Commercial |
$144.87
|
| Rate for Payer: Prime Health Services Commercial |
$189.45
|
| Rate for Payer: Riverside University Health System MISP |
$89.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$133.73
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$133.73
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.44
|
| Rate for Payer: United Healthcare All Other HMO |
$111.44
|
| Rate for Payer: United Healthcare HMO Rider |
$111.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$189.45
|
| Rate for Payer: Vantage Medical Group Senior |
$189.45
|
|
|
HC HALO ADDITION MRI COMPATIBLE
|
Facility
|
IP
|
$2,933.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$586.60 |
| Max. Negotiated Rate |
$2,639.70 |
| Rate for Payer: Blue Shield of California EPN |
$1,566.22
|
| Rate for Payer: Cash Price |
$1,319.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,346.40
|
| Rate for Payer: Cigna of CA HMO |
$2,053.10
|
| Rate for Payer: Cigna of CA PPO |
$2,053.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,173.20
|
| Rate for Payer: Galaxy Health WC |
$2,493.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,759.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,639.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,956.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,117.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.60
|
| Rate for Payer: Multiplan Commercial |
$2,199.75
|
| Rate for Payer: Networks By Design Commercial |
$1,466.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,493.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,107.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.69
|
| Rate for Payer: United Healthcare HMO Rider |
$1,058.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$967.89
|
|
|
HC HALO ADDITION MRI COMPATIBLE
|
Facility
|
OP
|
$2,933.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350860
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,026.55 |
| Max. Negotiated Rate |
$2,639.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,613.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,613.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,420.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,732.82
|
| Rate for Payer: Blue Distinction Transplant |
$1,759.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,199.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,595.55
|
| Rate for Payer: Cash Price |
$1,319.85
|
| Rate for Payer: Cash Price |
$1,319.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,346.40
|
| Rate for Payer: Cigna of CA HMO |
$2,053.10
|
| Rate for Payer: Cigna of CA PPO |
$2,053.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,493.05
|
| Rate for Payer: Dignity Health Media |
$2,493.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,493.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,173.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,173.20
|
| Rate for Payer: Galaxy Health WC |
$2,493.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,759.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,639.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,199.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,026.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,956.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,202.53
|
| Rate for Payer: Multiplan Commercial |
$2,199.75
|
| Rate for Payer: Networks By Design Commercial |
$1,466.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,493.05
|
| Rate for Payer: Riverside University Health System MISP |
$1,173.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,759.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,759.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,466.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,466.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,466.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,466.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,493.05
|
| Rate for Payer: Vantage Medical Group Senior |
$2,493.05
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$773.50 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,070.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,305.67
|
| Rate for Payer: Blue Distinction Transplant |
$1,326.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,657.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,202.24
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,878.50
|
| Rate for Payer: Dignity Health Media |
$1,878.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,878.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,657.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$773.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,393.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$906.10
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: Riverside University Health System MISP |
$884.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,326.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,326.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,105.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,105.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,105.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,105.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,878.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,878.50
|
|
|
HC HALO ADDITION MRI COMPATIBLE SYSTEM
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT L0859
|
| Hospital Charge Code |
905350859
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$442.00 |
| Max. Negotiated Rate |
$1,989.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,180.14
|
| Rate for Payer: Cash Price |
$994.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,768.00
|
| Rate for Payer: Cigna of CA HMO |
$1,547.00
|
| Rate for Payer: Cigna of CA PPO |
$1,547.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$884.00
|
| Rate for Payer: Galaxy Health WC |
$1,878.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,326.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,989.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,474.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$842.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.00
|
| Rate for Payer: Multiplan Commercial |
$1,657.50
|
| Rate for Payer: Networks By Design Commercial |
$1,105.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,878.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$834.50
|
| Rate for Payer: United Healthcare All Other HMO |
$815.05
|
| Rate for Payer: United Healthcare HMO Rider |
$797.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$729.30
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,238.00 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Blue Shield of California EPN |
$5,975.46
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,263.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,238.00
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,225.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4,126.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4,037.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,692.70
|
|
|
HC HALO PROCEDURE, W/VEST
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
CPT L0810
|
| Hospital Charge Code |
905350810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,536.11 |
| Max. Negotiated Rate |
$10,071.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,154.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,154.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,418.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,611.05
|
| Rate for Payer: Blue Distinction Transplant |
$6,714.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,392.50
|
| Rate for Payer: Blue Shield of California EPN |
$6,087.36
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Cash Price |
$5,035.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,952.00
|
| Rate for Payer: Cigna of CA HMO |
$7,833.00
|
| Rate for Payer: Cigna of CA PPO |
$7,833.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,511.50
|
| Rate for Payer: Dignity Health Media |
$9,511.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,511.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,476.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,476.00
|
| Rate for Payer: Galaxy Health WC |
$9,511.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,714.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,071.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,392.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,916.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,463.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,536.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,587.90
|
| Rate for Payer: Multiplan Commercial |
$8,392.50
|
| Rate for Payer: Networks By Design Commercial |
$5,595.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,511.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,476.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,714.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,714.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,595.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,595.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,595.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,595.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,511.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,511.50
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$118.65 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$288.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.28
|
| Rate for Payer: Blue Distinction Transplant |
$203.40
|
| Rate for Payer: Blue Shield of California Commercial |
$254.25
|
| Rate for Payer: Blue Shield of California EPN |
$184.42
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$288.15
|
| Rate for Payer: Dignity Health Media |
$288.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$288.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$254.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.99
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: Riverside University Health System MISP |
$135.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$203.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$203.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$169.50
|
| Rate for Payer: United Healthcare All Other HMO |
$169.50
|
| Rate for Payer: United Healthcare HMO Rider |
$169.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$169.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$288.15
|
| Rate for Payer: Vantage Medical Group Senior |
$288.15
|
|
|
HC HALO REPL LINER/INTERFACE
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT L0861
|
| Hospital Charge Code |
905350861
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.80 |
| Max. Negotiated Rate |
$305.10 |
| Rate for Payer: Blue Shield of California EPN |
$181.03
|
| Rate for Payer: Cash Price |
$152.55
|
| Rate for Payer: Central Health Plan Commercial |
$271.20
|
| Rate for Payer: Cigna of CA HMO |
$237.30
|
| Rate for Payer: Cigna of CA PPO |
$237.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$135.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$135.60
|
| Rate for Payer: Galaxy Health WC |
$288.15
|
| Rate for Payer: Global Benefits Group Commercial |
$203.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$305.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$226.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.80
|
| Rate for Payer: Multiplan Commercial |
$254.25
|
| Rate for Payer: Networks By Design Commercial |
$169.50
|
| Rate for Payer: Prime Health Services Commercial |
$288.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$128.01
|
| Rate for Payer: United Healthcare All Other HMO |
$125.02
|
| Rate for Payer: United Healthcare HMO Rider |
$122.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$111.87
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$116.01 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$449.40
|
| Rate for Payer: Caremore Medicare Advantage |
$497.82
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Central Health Plan Commercial |
$599.20
|
| Rate for Payer: Cigna of CA PPO |
$554.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$674.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$561.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: InnovAge PACE Commercial |
$746.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
| Rate for Payer: Prime Health Services Medicare |
$527.69
|
| Rate for Payer: Riverside University Health System MISP |
$547.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$449.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$374.50
|
| Rate for Payer: United Healthcare All Other HMO |
$374.50
|
| Rate for Payer: United Healthcare HMO Rider |
$374.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$374.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC HALO/TONGS REMOVAL
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT 20665
|
| Hospital Charge Code |
900501562
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Central Health Plan Commercial |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.60
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$674.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
|
|
HC HAND COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$972.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.77 |
| Max. Negotiated Rate |
$874.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.78
|
| 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 |
$110.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.65
|
| Rate for Payer: Blue Distinction Transplant |
$583.20
|
| Rate for Payer: Blue Shield of California Commercial |
$600.70
|
| Rate for Payer: Blue Shield of California EPN |
$472.39
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Central Health Plan Commercial |
$777.60
|
| Rate for Payer: Cigna of CA HMO |
$622.08
|
| Rate for Payer: Cigna of CA PPO |
$719.28
|
| 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 |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$874.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$729.00
|
| 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 |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| 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 |
$729.00
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
| 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 |
$583.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$583.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: 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 HAND COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$972.00
|
|
|
Service Code
|
CPT 73130
|
| Hospital Charge Code |
909001520
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.40 |
| Max. Negotiated Rate |
$874.80 |
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Central Health Plan Commercial |
$777.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.80
|
| Rate for Payer: Galaxy Health WC |
$826.20
|
| Rate for Payer: Global Benefits Group Commercial |
$583.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$874.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$648.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.40
|
| Rate for Payer: Multiplan Commercial |
$729.00
|
| Rate for Payer: Networks By Design Commercial |
$631.80
|
| Rate for Payer: Prime Health Services Commercial |
$826.20
|
|
|
HC HAND LIMITED 2 VIEWS
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$109.83
|
| 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 |
$102.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.22
|
| Rate for Payer: Blue Distinction Transplant |
$581.40
|
| Rate for Payer: Blue Shield of California Commercial |
$598.84
|
| Rate for Payer: Blue Shield of California EPN |
$470.93
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$436.05
|
| Rate for Payer: Cash Price |
$436.05
|
| Rate for Payer: Central Health Plan Commercial |
$775.20
|
| Rate for Payer: Cigna of CA HMO |
$620.16
|
| Rate for Payer: Cigna of CA PPO |
$717.06
|
| 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 |
$823.65
|
| Rate for Payer: Global Benefits Group Commercial |
$581.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$872.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$726.75
|
| 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 |
$646.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.80
|
| 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 |
$726.75
|
| Rate for Payer: Networks By Design Commercial |
$629.85
|
| Rate for Payer: Prime Health Services Commercial |
$823.65
|
| 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 |
$581.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$581.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: 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 HAND LIMITED 2 VIEWS
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
909001518
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.80 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Cash Price |
$436.05
|
| Rate for Payer: Central Health Plan Commercial |
$775.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$387.60
|
| Rate for Payer: Galaxy Health WC |
$823.65
|
| Rate for Payer: Global Benefits Group Commercial |
$581.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$872.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.80
|
| Rate for Payer: Multiplan Commercial |
$726.75
|
| Rate for Payer: Networks By Design Commercial |
$629.85
|
| Rate for Payer: Prime Health Services Commercial |
$823.65
|
|
|
HC HAND MUSCLE TESTING MANUAL OT
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905104403
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$88.90 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$215.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$139.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$139.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$152.40
|
| 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 |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: Cigna of CA HMO |
$162.56
|
| Rate for Payer: Cigna of CA PPO |
$187.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$215.90
|
| Rate for Payer: Dignity Health Media |
$215.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$190.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.14
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
| Rate for Payer: Riverside University Health System MISP |
$101.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$152.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$152.40
|
| 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 |
$215.90
|
| Rate for Payer: Vantage Medical Group Senior |
$215.90
|
|
|
HC HAND MUSCLE TESTING MANUAL OT
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 95832
|
| Hospital Charge Code |
905104403
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$228.60 |
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Central Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.60
|
| Rate for Payer: Galaxy Health WC |
$215.90
|
| Rate for Payer: Global Benefits Group Commercial |
$152.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$169.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$190.50
|
| Rate for Payer: Networks By Design Commercial |
$165.10
|
| Rate for Payer: Prime Health Services Commercial |
$215.90
|
|
