|
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: 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 Permanente of CA Commercial/Self Funded |
$569.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$528.63
|
| 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 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 |
$489.22
|
| Rate for Payer: Blue Shield of California Commercial |
$508.96
|
| 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: 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: InnovAge PACE Commercial |
$416.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$583.10
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.63
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,193.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$681.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,108.01
|
| 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-COMPLETE
|
Facility
|
OP
|
$1,790.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$1,611.00 |
| Rate for Payer: Adventist Health Commercial |
$358.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,087.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.53
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,193.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,342.50
|
| Rate for Payer: Networks By Design Commercial |
$1,163.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,521.50
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$711.85
|
| 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 LIMITED
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
909001123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$698.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.04
|
| Rate for Payer: Blue Shield of California Commercial |
$698.05
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC MANDIBLE-PANOREX
|
Facility
|
OP
|
$1,063.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
909001124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$956.70 |
| Rate for Payer: Adventist Health Commercial |
$212.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$645.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.08
|
| Rate for Payer: Blue Shield of California Commercial |
$645.24
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$797.25
|
| Rate for Payer: Networks By Design Commercial |
$690.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$903.55
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$709.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$658.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| 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 |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$110.70
|
| 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: 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: InnovAge PACE Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$110.70
|
| 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: 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: InnovAge PACE Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| 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 OT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905197140
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| 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 OT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905197140
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$110.70
|
| 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: 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: InnovAge PACE Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA 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 PT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900417140
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| 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 PT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900417140
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$110.70
|
| 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: 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: InnovAge PACE Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA 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 PT
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905103160
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| 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 PT
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905103160
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$38.20 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$100.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.40
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$110.70
|
| 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: 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: InnovAge PACE Commercial |
$123.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.20
|
| Rate for Payer: Molina Healthcare of CA 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 MARATHON LIQUID SKIN PROTECTANT
|
Facility
|
IP
|
$43.38
|
|
| Hospital Charge Code |
901607240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$39.04 |
| Rate for Payer: Adventist Health Commercial |
$8.68
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Central Health Plan Commercial |
$34.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.35
|
| Rate for Payer: EPIC Health Plan Senior |
$17.35
|
| Rate for Payer: Galaxy Health WC |
$36.87
|
| Rate for Payer: Global Benefits Group Commercial |
$26.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$32.53
|
| Rate for Payer: Networks By Design Commercial |
$28.20
|
| Rate for Payer: Prime Health Services Commercial |
$36.87
|
|
|
HC MARATHON LIQUID SKIN PROTECTANT
|
Facility
|
OP
|
$43.38
|
|
| Hospital Charge Code |
901607240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$39.04 |
| Rate for Payer: Adventist Health Commercial |
$8.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.48
|
| Rate for Payer: Blue Shield of California Commercial |
$26.51
|
| Rate for Payer: Blue Shield of California EPN |
$17.31
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Central Health Plan Commercial |
$34.70
|
| Rate for Payer: Cigna of CA HMO |
$27.76
|
| Rate for Payer: Cigna of CA PPO |
$32.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.35
|
| Rate for Payer: EPIC Health Plan Senior |
$17.35
|
| Rate for Payer: Galaxy Health WC |
$36.87
|
| Rate for Payer: Global Benefits Group Commercial |
$26.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.04
|
| Rate for Payer: InnovAge PACE Commercial |
$21.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.37
|
| Rate for Payer: Multiplan Commercial |
$32.53
|
| Rate for Payer: Networks By Design Commercial |
$28.20
|
| Rate for Payer: Prime Health Services Commercial |
$36.87
|
| Rate for Payer: Riverside University Health System MISP |
$17.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.87
|
| Rate for Payer: Vantage Medical Group Senior |
$36.87
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
915353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Blue Shield of California Commercial |
$63.39
|
| Rate for Payer: Blue Shield of California EPN |
$41.33
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
905353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Blue Shield of California Commercial |
$63.39
|
| Rate for Payer: Blue Shield of California EPN |
$41.33
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
915353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$63.39
|
| Rate for Payer: Blue Shield of California EPN |
$41.33
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.51
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
905353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$63.39
|
| Rate for Payer: Blue Shield of California EPN |
$41.33
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.51
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
