|
HC MASSAGE 15 MIN MCAL
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| 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 |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$17.70
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC MASSAGE 15 MIN OT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905104145
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| 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 |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$17.70
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC MASSAGE 15 MIN OT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905104145
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| 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 Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| 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 MASSAGE 15 MIN PT
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905103145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| 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 Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| 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 MASSAGE 15 MIN PT
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905103145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| 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 |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$17.70
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC MASSAGE 15 MIN PT COMM MCARE
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900417124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$176.40 |
| Rate for Payer: Adventist Health Commercial |
$39.20
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| 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 Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| 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 MASSAGE 15 MIN PT COMM MCARE
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900417124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.70 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$80.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.00
|
| 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 |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Cash Price |
$107.80
|
| Rate for Payer: Central Health Plan Commercial |
$156.80
|
| Rate for Payer: Cigna of CA HMO |
$125.44
|
| Rate for Payer: Cigna of CA PPO |
$145.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.60
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$17.70
|
| Rate for Payer: InnovAge PACE Commercial |
$98.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.20
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$78.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.60
|
| 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 |
$166.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.60
|
| Rate for Payer: Vantage Medical Group Senior |
$166.60
|
|
|
HC MASTOID CHILD
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$698.39
|
| 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 |
$698.05
|
| Rate for Payer: Blue Shield of California EPN |
$456.55
|
| Rate for Payer: Cash Price |
$632.50
|
| Rate for Payer: Cash Price |
$632.50
|
| 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 |
$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 |
$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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| 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 |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| 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 |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| 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 |
$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 |
$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 MASTOID CHILD
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
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 |
$632.50
|
| 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 MASTOID COMPLETE
|
Facility
|
IP
|
$1,150.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
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 |
$632.50
|
| 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 MASTOID COMPLETE
|
Facility
|
OP
|
$1,150.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$1,035.00 |
| Rate for Payer: Adventist Health Commercial |
$230.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$698.39
|
| 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 |
$164.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.36
|
| 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 |
$632.50
|
| Rate for Payer: Cash Price |
$632.50
|
| 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 |
$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 |
$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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.84
|
| 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 |
$767.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.00
|
| 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 |
$862.50
|
| Rate for Payer: Networks By Design Commercial |
$747.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$977.50
|
| 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 |
$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 |
$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 MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
IP
|
$9,145.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,829.00 |
| Max. Negotiated Rate |
$8,230.50 |
| Rate for Payer: Adventist Health Commercial |
$1,829.00
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,316.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,658.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,658.00
|
| Rate for Payer: Galaxy Health WC |
$7,773.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,487.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,230.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,099.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,660.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,829.00
|
| Rate for Payer: Multiplan Commercial |
$6,858.75
|
| Rate for Payer: Networks By Design Commercial |
$5,944.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,773.25
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
OP
|
$9,145.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$8,230.50 |
| Rate for Payer: Adventist Health Commercial |
$3,749.45
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,316.00
|
| Rate for Payer: Cigna of CA HMO |
$5,852.80
|
| Rate for Payer: Cigna of CA PPO |
$6,767.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$7,773.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,487.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,230.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,099.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,829.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$6,858.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,944.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$7,773.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,487.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,487.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
IP
|
$9,145.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,829.00 |
| Max. Negotiated Rate |
$8,230.50 |
| Rate for Payer: Adventist Health Commercial |
$1,829.00
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,316.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,658.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,658.00
|
| Rate for Payer: Galaxy Health WC |
$7,773.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,487.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,230.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,099.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,660.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,829.00
|
| Rate for Payer: Multiplan Commercial |
$6,858.75
|
| Rate for Payer: Networks By Design Commercial |
$5,944.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,773.25
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
IP
|
$9,145.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,829.00 |
| Max. Negotiated Rate |
$8,230.50 |
| Rate for Payer: Adventist Health Commercial |
$1,829.00
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,316.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,658.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,658.00
|
| Rate for Payer: Galaxy Health WC |
$7,773.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,487.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,230.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,099.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,484.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,660.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,829.00
|
| Rate for Payer: Multiplan Commercial |
$6,858.75
|
| Rate for Payer: Networks By Design Commercial |
$5,944.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,773.25
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
OP
|
$9,145.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$8,230.50 |
| Rate for Payer: Adventist Health Commercial |
$1,829.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,316.00
|
| Rate for Payer: Cigna of CA HMO |
$5,852.80
|
| Rate for Payer: Cigna of CA PPO |
$6,767.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$7,773.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,487.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,230.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,099.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,829.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$6,858.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,944.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$7,773.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,487.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,572.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,572.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,572.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,572.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
OP
|
$9,145.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,829.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,058.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,280.13
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Cash Price |
$5,029.75
|
| Rate for Payer: Central Health Plan Commercial |
$7,316.00
|
| Rate for Payer: Cigna of CA HMO |
$5,852.80
|
| Rate for Payer: Cigna of CA PPO |
$6,767.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$7,773.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,487.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,230.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3,088.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,099.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,829.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,758.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$6,858.75
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,944.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Preferred Health Network WC |
$3,347.07
|
| Rate for Payer: Prime Health Services Commercial |
$7,773.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,182.20
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Riverside University Health System MISP |
$2,264.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,487.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC MATRISTEM MICROMATRIX PER 1MG
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT Q4118
|
| Hospital Charge Code |
900101466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.22
|
| Rate for Payer: Blue Shield of California Commercial |
$8.55
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$9.80
|
| Rate for Payer: Cigna of CA PPO |
$9.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.55
|
| Rate for Payer: InnovAge PACE Commercial |
$7.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Riverside University Health System MISP |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.11
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
HC MATRISTEM MICROMATRIX PER 1MG
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT Q4118
|
| Hospital Charge Code |
900101466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Blue Shield of California Commercial |
$10.82
|
| Rate for Payer: Blue Shield of California EPN |
$7.06
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$9.80
|
| Rate for Payer: Cigna of CA PPO |
$9.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.25
|
| Rate for Payer: United Healthcare All Other HMO |
$5.11
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.58
|
|
|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
IP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,797.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,278.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Cigna of CA HMO |
$1,627.50
|
| Rate for Payer: Cigna of CA PPO |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,550.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,439.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Networks By Design Commercial |
$1,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$872.57
|
| Rate for Payer: United Healthcare All Other HMO |
$849.32
|
| Rate for Payer: United Healthcare HMO Rider |
$830.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.44
|
|
|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
OP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$2,092.50 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,278.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,743.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,061.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,287.35
|
| Rate for Payer: Blue Shield of California Commercial |
$1,797.22
|
| Rate for Payer: Blue Shield of California EPN |
$1,171.80
|
| Rate for Payer: Cash Price |
$1,278.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,860.00
|
| Rate for Payer: Cigna of CA HMO |
$1,627.50
|
| Rate for Payer: Cigna of CA PPO |
$1,627.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,976.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,976.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,092.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,162.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,550.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,439.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,627.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,627.50
|
| Rate for Payer: Multiplan Commercial |
$1,743.75
|
| Rate for Payer: Networks By Design Commercial |
$1,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: Riverside University Health System MISP |
$930.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,395.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,395.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$872.57
|
| Rate for Payer: United Healthcare All Other HMO |
$849.32
|
| Rate for Payer: United Healthcare HMO Rider |
$830.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,976.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,976.25
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
OP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$3,586.50 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,191.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,988.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,819.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,206.49
|
| Rate for Payer: Blue Shield of California Commercial |
$3,080.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,008.44
|
| Rate for Payer: Cash Price |
$2,191.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,188.00
|
| Rate for Payer: Cigna of CA HMO |
$2,789.50
|
| Rate for Payer: Cigna of CA PPO |
$2,789.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,387.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,387.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,594.00
|
| Rate for Payer: Galaxy Health WC |
$3,387.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,391.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,586.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,992.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,657.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,466.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,789.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,789.50
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: Networks By Design Commercial |
$1,992.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,387.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,594.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,391.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,391.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,495.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,455.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,424.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,387.25
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
IP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$3,586.50 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,080.41
|
| Rate for Payer: Blue Shield of California EPN |
$2,008.44
|
| Rate for Payer: Cash Price |
$2,191.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,188.00
|
| Rate for Payer: Cigna of CA HMO |
$2,789.50
|
| Rate for Payer: Cigna of CA PPO |
$2,789.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,594.00
|
| Rate for Payer: Galaxy Health WC |
$3,387.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,391.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,586.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,657.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,466.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$797.00
|
| Rate for Payer: Multiplan Commercial |
$2,988.75
|
| Rate for Payer: Networks By Design Commercial |
$1,992.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,387.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,495.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,455.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,424.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.09
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
OP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,420.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,300.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,009.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,436.28
|
| Rate for Payer: Blue Shield of California Commercial |
$3,401.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,420.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,080.00
|
| Rate for Payer: Cigna of CA PPO |
$3,080.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,740.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,740.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,760.00
|
| Rate for Payer: Galaxy Health WC |
$3,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,640.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,960.00
|
| Rate for Payer: InnovAge PACE Commercial |
$2,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,934.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,676.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,723.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,080.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,080.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,740.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,760.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,640.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,640.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,651.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,607.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,572.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,740.00
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
IP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$3,960.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,401.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,217.60
|
| Rate for Payer: Cash Price |
$2,420.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,520.00
|
| Rate for Payer: Cigna of CA HMO |
$3,080.00
|
| Rate for Payer: Cigna of CA PPO |
$3,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,760.00
|
| Rate for Payer: Galaxy Health WC |
$3,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,640.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,960.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,934.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,676.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,723.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$880.00
|
| Rate for Payer: Multiplan Commercial |
$3,300.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,740.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,651.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,607.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,572.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,441.00
|
|
