|
HC MAGNETIC RESONANCE ELSTGRPHY
|
Facility
|
IP
|
$2,440.00
|
|
|
Service Code
|
CPT 76391
|
| Hospital Charge Code |
908876391
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$488.00 |
| Max. Negotiated Rate |
$2,196.00 |
| Rate for Payer: Adventist Health Commercial |
$488.00
|
| Rate for Payer: Cash Price |
$1,098.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,952.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,708.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$976.00
|
| Rate for Payer: EPIC Health Plan Senior |
$976.00
|
| Rate for Payer: Galaxy Health WC |
$2,074.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,464.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,196.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,549.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,439.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$488.00
|
| Rate for Payer: Multiplan Commercial |
$1,830.00
|
| Rate for Payer: Networks By Design Commercial |
$1,586.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,074.00
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California Commercial |
$123.48
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Blue Shield of California EPN |
$77.81
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.88
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.99
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Prime Health Services Medicare |
$6.35
|
| Rate for Payer: Prime Health Services Medicare |
$6.35
|
| Rate for Payer: Riverside University Health System MISP |
$6.59
|
| Rate for Payer: Riverside University Health System MISP |
$6.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA QUANTITAT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911640
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC MALARIA SCREEN AG TEST
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87899
|
| Hospital Charge Code |
900912441
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.38 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.90
|
| Rate for Payer: Blue Shield of California Commercial |
$23.94
|
| Rate for Payer: Blue Shield of California Commercial |
$123.48
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Blue Shield of California EPN |
$77.81
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.52
|
| Rate for Payer: EPIC Health Plan Senior |
$17.68
|
| Rate for Payer: EPIC Health Plan Senior |
$17.68
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.53
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.07
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.07
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Prime Health Services Medicare |
$17.03
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Riverside University Health System MISP |
$17.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare All Other HMO |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare HMO Rider |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.68
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
| Rate for Payer: Vantage Medical Group Senior |
$16.07
|
|
|
HC MALARIA SMEARS
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.85 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.99
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.60
|
| Rate for Payer: Blue Shield of California Commercial |
$26.46
|
| Rate for Payer: Blue Shield of California Commercial |
$123.48
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Blue Shield of California EPN |
$77.81
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.88
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: EPIC Health Plan Senior |
$6.59
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.82
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.03
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.99
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.99
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
| Rate for Payer: Prime Health Services Medicare |
$6.35
|
| Rate for Payer: Prime Health Services Medicare |
$6.35
|
| Rate for Payer: Riverside University Health System MISP |
$6.59
|
| Rate for Payer: Riverside University Health System MISP |
$6.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.59
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
| Rate for Payer: Vantage Medical Group Senior |
$5.99
|
|
|
HC MALARIA SMEARS
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
900911686
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$88.20
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$137.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Senior |
$78.40
|
| Rate for Payer: Galaxy Health WC |
$166.60
|
| Rate for Payer: Global Benefits Group Commercial |
$117.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$176.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$124.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$115.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$147.00
|
| Rate for Payer: Networks By Design Commercial |
$127.40
|
| Rate for Payer: Prime Health Services Commercial |
$166.60
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
OP
|
$750.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$562.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$480.00
|
| Rate for Payer: Cigna of CA PPO |
$555.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$637.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$637.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$332.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$525.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Riverside University Health System MISP |
$300.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$637.50
|
| Rate for Payer: Vantage Medical Group Senior |
$637.50
|
|
|
HC MAMMARY DUCTOGRAM
|
Facility
|
IP
|
$750.00
|
|
|
Service Code
|
CPT 19030
|
| Hospital Charge Code |
909000103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Adventist Health Commercial |
$150.00
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$525.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: EPIC Health Plan Senior |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$476.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$442.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
OP
|
$1,050.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$741.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$577.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$787.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$714.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$610.78
|
| Rate for Payer: Blue Shield of California Commercial |
$661.50
|
| Rate for Payer: Blue Shield of California EPN |
$416.85
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Central Health Plan Commercial |
$840.00
|
| Rate for Payer: Cigna of CA HMO |
$672.00
|
| Rate for Payer: Cigna of CA PPO |
$777.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$892.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$892.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$892.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$945.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$254.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$666.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$281.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$619.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$735.00
|
| Rate for Payer: Multiplan Commercial |
$787.50
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
| Rate for Payer: Riverside University Health System MISP |
$420.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.54
|
| Rate for Payer: United Healthcare All Other HMO |
$321.54
|
| Rate for Payer: United Healthcare HMO Rider |
$321.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$892.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$892.50
|
| Rate for Payer: Vantage Medical Group Senior |
$892.50
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
IP
|
$1,050.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$945.00 |
| Rate for Payer: Adventist Health Commercial |
$210.00
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Central Health Plan Commercial |
$840.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.00
|
| Rate for Payer: EPIC Health Plan Senior |
$420.00
|
| Rate for Payer: Galaxy Health WC |
$892.50
|
| Rate for Payer: Global Benefits Group Commercial |
$630.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$945.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$666.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$619.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$787.50
|
| Rate for Payer: Networks By Design Commercial |
$682.50
|
| Rate for Payer: Prime Health Services Commercial |
$892.50
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
IP
|
$854.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$768.60 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Central Health Plan Commercial |
$683.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$597.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.60
|
| Rate for Payer: EPIC Health Plan Senior |
$341.60
|
| Rate for Payer: Galaxy Health WC |
$725.90
|
| Rate for Payer: Global Benefits Group Commercial |
$512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$542.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$503.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
| Rate for Payer: Networks By Design Commercial |
$555.10
|
| Rate for Payer: Prime Health Services Commercial |
$725.90
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
OP
|
$854.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$170.80 |
| Max. Negotiated Rate |
$768.60 |
| Rate for Payer: Adventist Health Commercial |
$170.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$579.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$725.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$469.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$640.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$558.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.77
|
| Rate for Payer: Blue Shield of California Commercial |
$538.02
|
| Rate for Payer: Blue Shield of California EPN |
$339.04
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Cash Price |
$384.30
|
| Rate for Payer: Central Health Plan Commercial |
$683.20
|
| Rate for Payer: Cigna of CA HMO |
$546.56
|
| Rate for Payer: Cigna of CA PPO |
$631.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$725.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$725.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$725.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$597.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$341.60
|
| Rate for Payer: EPIC Health Plan Senior |
$341.60
|
| Rate for Payer: Galaxy Health WC |
$725.90
|
| Rate for Payer: Global Benefits Group Commercial |
$512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$768.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$201.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$542.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$222.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$503.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$597.80
|
| Rate for Payer: Multiplan Commercial |
$640.50
|
| Rate for Payer: Networks By Design Commercial |
$555.10
|
| Rate for Payer: Prime Health Services Commercial |
$725.90
|
| Rate for Payer: Riverside University Health System MISP |
$341.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$512.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$512.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.70
|
| Rate for Payer: United Healthcare All Other HMO |
$252.70
|
| Rate for Payer: United Healthcare HMO Rider |
$252.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$725.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$725.90
|
| Rate for Payer: Vantage Medical Group Senior |
$725.90
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
OP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$505.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$624.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$403.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$484.56
|
| Rate for Payer: Blue Shield of California Commercial |
$528.12
|
| Rate for Payer: Blue Shield of California EPN |
$332.37
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$533.12
|
| Rate for Payer: Cigna of CA PPO |
$616.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$708.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$302.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$583.10
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Riverside University Health System MISP |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other HMO |
$416.50
|
| Rate for Payer: United Healthcare HMO Rider |
$416.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$416.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
IP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$166.60
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Senior |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$528.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$491.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.55 |
| Max. Negotiated Rate |
$1,611.00 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,127.70
|
| Rate for Payer: Blue Shield of California EPN |
$710.63
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.00
|
| Rate for Payer: Cigna of CA HMO |
$1,145.60
|
| Rate for Payer: Cigna of CA PPO |
$1,324.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,253.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,521.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,136.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
| Rate for Payer: Networks By Design Commercial |
$1,163.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,521.50
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,074.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,074.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
IP
|
$1,790.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$358.00 |
| Max. Negotiated Rate |
$1,611.00 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Cash Price |
$805.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,253.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.00
|
| Rate for Payer: EPIC Health Plan Senior |
$716.00
|
| Rate for Payer: Galaxy Health WC |
$1,521.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,136.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,056.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.00
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
| Rate for Payer: Networks By Design Commercial |
$1,163.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,521.50
|
|
|
HC MANDIBLE LIMITED
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
909001123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.17 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.96
|
| Rate for Payer: Blue Shield of California Commercial |
$724.50
|
| Rate for Payer: Blue Shield of California EPN |
$456.55
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: Cigna of CA HMO |
$736.00
|
| Rate for Payer: Cigna of CA PPO |
$851.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$805.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$730.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$690.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MANDIBLE LIMITED
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
909001123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.00 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Central Health Plan Commercial |
$920.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$805.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.00
|
| Rate for Payer: EPIC Health Plan Senior |
$460.00
|
| Rate for Payer: Galaxy Health WC |
$977.50
|
| Rate for Payer: Global Benefits Group Commercial |
$690.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$730.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$678.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
|
|
HC MANDIBLE-PANOREX
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
909001124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.59 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Adventist Health Commercial |
$212.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.98
|
| Rate for Payer: Blue Shield of California Commercial |
$669.69
|
| Rate for Payer: Blue Shield of California EPN |
$422.01
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Cigna of CA HMO |
$680.32
|
| Rate for Payer: Cigna of CA PPO |
$786.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$690.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$637.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$637.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.10
|
| Rate for Payer: United Healthcare All Other HMO |
$82.10
|
| Rate for Payer: United Healthcare HMO Rider |
$82.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.10
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC MANDIBLE-PANOREX
|
Facility
|
IP
|
$1,063.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
909001124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.60 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Adventist Health Commercial |
$212.60
|
| Rate for Payer: Cash Price |
$478.35
|
| Rate for Payer: Central Health Plan Commercial |
$850.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$744.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.20
|
| Rate for Payer: EPIC Health Plan Senior |
$425.20
|
| Rate for Payer: Galaxy Health WC |
$903.55
|
| Rate for Payer: Global Benefits Group Commercial |
$637.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$956.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$627.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.60
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$690.95
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
901300057
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900400053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$221.40 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900400053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
901300057
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$184.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Central Health Plan Commercial |
$196.80
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$221.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$172.20
|
| Rate for Payer: Multiplan Commercial |
$184.50
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Riverside University Health System MISP |
$98.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.10
|
| Rate for Payer: Vantage Medical Group Senior |
$209.10
|
|
