|
HC PEL OVULATION STUDY
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.53 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$394.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$219.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$680.59
|
| Rate for Payer: Blue Shield of California Commercial |
$737.10
|
| Rate for Payer: Blue Shield of California EPN |
$464.49
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$819.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$742.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$80.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC PEL OVULATION STUDY
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 76857
|
| Hospital Charge Code |
906601204
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Adventist Health Commercial |
$234.00
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$819.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: EPIC Health Plan Senior |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$742.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$690.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Adventist Health Commercial |
$540.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$989.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,057.84
|
| Rate for Payer: Blue Shield of California EPN |
$664.78
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,121.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,121.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$285.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$923.30
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Riverside University Health System MISP |
$527.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,121.15
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
905352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,057.84
|
| Rate for Payer: Blue Shield of California EPN |
$664.78
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.80
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
915352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,057.84
|
| Rate for Payer: Blue Shield of California EPN |
$664.78
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.80
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
|
|
HC PELVIC CONT BAND/BELT BILATERA
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT L2640
|
| Hospital Charge Code |
915352640
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$285.40 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Adventist Health Commercial |
$540.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$725.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$989.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,057.84
|
| Rate for Payer: Blue Shield of California EPN |
$664.78
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$923.30
|
| Rate for Payer: Cigna of CA PPO |
$923.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,121.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,121.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$923.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$285.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$837.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$778.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$923.30
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$659.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Riverside University Health System MISP |
$527.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.02
|
| Rate for Payer: United Healthcare All Other HMO |
$481.83
|
| Rate for Payer: United Healthcare HMO Rider |
$471.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$431.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,121.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,121.15
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
915352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Blue Shield of California Commercial |
$638.39
|
| Rate for Payer: Blue Shield of California EPN |
$401.18
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
915352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$326.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.03
|
| Rate for Payer: Blue Shield of California Commercial |
$638.39
|
| Rate for Payer: Blue Shield of California EPN |
$401.18
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$676.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Riverside University Health System MISP |
$318.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.72 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$326.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$437.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.03
|
| Rate for Payer: Blue Shield of California Commercial |
$638.39
|
| Rate for Payer: Blue Shield of California EPN |
$401.18
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$676.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$676.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$676.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$326.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$557.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$398.00
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Riverside University Health System MISP |
$318.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$676.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$676.60
|
| Rate for Payer: Vantage Medical Group Senior |
$676.60
|
|
|
HC PELVIC CONTROL BAND AND BELT
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT L2630
|
| Hospital Charge Code |
905352630
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$716.40 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Blue Shield of California Commercial |
$638.39
|
| Rate for Payer: Blue Shield of California EPN |
$401.18
|
| Rate for Payer: Cash Price |
$358.20
|
| Rate for Payer: Central Health Plan Commercial |
$636.80
|
| Rate for Payer: Cigna of CA HMO |
$557.20
|
| Rate for Payer: Cigna of CA PPO |
$557.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$557.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$716.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$505.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$469.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$159.20
|
| Rate for Payer: Multiplan Commercial |
$597.00
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.74
|
| Rate for Payer: United Healthcare All Other HMO |
$290.78
|
| Rate for Payer: United Healthcare HMO Rider |
$284.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.69
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
IP
|
$10,380.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,076.00 |
| Max. Negotiated Rate |
$9,342.00 |
| Rate for Payer: Adventist Health Commercial |
$2,076.00
|
| Rate for Payer: Cash Price |
$4,671.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,304.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,266.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,152.00
|
| Rate for Payer: Galaxy Health WC |
$8,823.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,591.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,124.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.00
|
| Rate for Payer: Multiplan Commercial |
$7,785.00
|
| Rate for Payer: Networks By Design Commercial |
$6,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,823.00
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$10,380.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.98 |
| Max. Negotiated Rate |
$9,342.00 |
| Rate for Payer: Adventist Health Commercial |
$2,076.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$662.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,580.92
|
| Rate for Payer: Blue Shield of California EPN |
$4,141.62
|
| Rate for Payer: Cash Price |
$4,671.00
|
| Rate for Payer: Cash Price |
$4,671.00
|
| Rate for Payer: Cash Price |
$4,671.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,304.00
|
| Rate for Payer: Cigna of CA HMO |
$6,643.20
|
| Rate for Payer: Cigna of CA PPO |
$7,681.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,266.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$8,823.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,342.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,591.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$7,785.00
|
| Rate for Payer: Networks By Design Commercial |
$6,747.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Prime Health Services Commercial |
$8,823.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,228.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,190.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,190.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,190.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,190.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
IP
|
$10,380.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,076.00 |
| Max. Negotiated Rate |
$9,342.00 |
| Rate for Payer: Adventist Health Commercial |
$2,076.00
|
| Rate for Payer: Cash Price |
$4,671.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,304.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,266.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,152.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,152.00
|
| Rate for Payer: Galaxy Health WC |
$8,823.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,342.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,591.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,124.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.00
|
| Rate for Payer: Multiplan Commercial |
$7,785.00
|
| Rate for Payer: Networks By Design Commercial |
$6,747.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,823.00
|
|
|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$10,380.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$9,342.00 |
| Rate for Payer: Adventist Health Commercial |
$2,076.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$4,671.00
|
| Rate for Payer: Cash Price |
$4,671.00
|
| Rate for Payer: Cash Price |
$4,671.00
|
| Rate for Payer: Cash Price |
$4,671.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,304.00
|
| Rate for Payer: Cigna of CA HMO |
$6,643.20
|
| Rate for Payer: Cigna of CA PPO |
$7,681.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,266.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$8,823.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,228.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,342.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,591.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,076.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$7,785.00
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$6,747.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$8,823.00
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,228.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,190.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,190.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,190.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,190.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$831.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,146.86
|
| Rate for Payer: Blue Shield of California EPN |
$720.72
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$530.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$843.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Riverside University Health System MISP |
$572.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,146.86
|
| Rate for Payer: Blue Shield of California EPN |
$720.72
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$843.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$929.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$468.32 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$831.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,146.86
|
| Rate for Payer: Blue Shield of California EPN |
$720.72
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$530.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$843.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Riverside University Health System MISP |
$572.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$1,287.00 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,146.86
|
| Rate for Payer: Blue Shield of California EPN |
$720.72
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,144.00
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,287.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$843.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.00
|
| Rate for Payer: Multiplan Commercial |
$1,072.50
|
| Rate for Payer: Networks By Design Commercial |
$929.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIMMETRY
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC PELVIMMETRY
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$258.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$352.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$304.43
|
| Rate for Payer: Blue Shield of California Commercial |
$296.10
|
| Rate for Payer: Blue Shield of California EPN |
$186.59
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$399.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$399.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$329.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Riverside University Health System MISP |
$188.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$399.50
|
| Rate for Payer: Vantage Medical Group Senior |
$399.50
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
IP
|
$919.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$183.80 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Central Health Plan Commercial |
$735.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$643.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$367.60
|
| Rate for Payer: EPIC Health Plan Senior |
$367.60
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$827.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$583.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$542.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.80
|
| Rate for Payer: Multiplan Commercial |
$689.25
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
OP
|
$919.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$37.19 |
| Max. Negotiated Rate |
$827.10 |
| Rate for Payer: Adventist Health Commercial |
$183.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$151.02
|
| Rate for Payer: Blue Shield of California Commercial |
$578.97
|
| Rate for Payer: Blue Shield of California EPN |
$364.84
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Cash Price |
$413.55
|
| Rate for Payer: Central Health Plan Commercial |
$735.20
|
| Rate for Payer: Cigna of CA HMO |
$588.16
|
| Rate for Payer: Cigna of CA PPO |
$680.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$643.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$781.15
|
| Rate for Payer: Global Benefits Group Commercial |
$551.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$827.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$583.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$689.25
|
| Rate for Payer: Networks By Design Commercial |
$597.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$781.15
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$551.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$551.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$1,471.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.20 |
| Max. Negotiated Rate |
$1,323.90 |
| Rate for Payer: Adventist Health Commercial |
$294.20
|
| Rate for Payer: Cash Price |
$661.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,176.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,029.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.40
|
| Rate for Payer: EPIC Health Plan Senior |
$588.40
|
| Rate for Payer: Galaxy Health WC |
$1,250.35
|
| Rate for Payer: Global Benefits Group Commercial |
$882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,323.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$867.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.20
|
| Rate for Payer: Multiplan Commercial |
$1,103.25
|
| Rate for Payer: Networks By Design Commercial |
$956.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,250.35
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$1,471.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.27 |
| Max. Negotiated Rate |
$1,323.90 |
| Rate for Payer: Adventist Health Commercial |
$294.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$195.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.92
|
| Rate for Payer: Blue Shield of California Commercial |
$926.73
|
| Rate for Payer: Blue Shield of California EPN |
$583.99
|
| Rate for Payer: Cash Price |
$661.95
|
| Rate for Payer: Cash Price |
$661.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,176.80
|
| Rate for Payer: Cigna of CA HMO |
$941.44
|
| Rate for Payer: Cigna of CA PPO |
$1,088.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,029.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,250.35
|
| Rate for Payer: Global Benefits Group Commercial |
$882.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,323.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$54.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$934.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,103.25
|
| Rate for Payer: Networks By Design Commercial |
$956.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,250.35
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$882.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$882.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC PEN A 1 (SHRIMP), IGE
|
Facility
|
OP
|
$16.29
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913751
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$167.30 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.30
|
| Rate for Payer: Blue Shield of California Commercial |
$10.26
|
| Rate for Payer: Blue Shield of California EPN |
$6.47
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Central Health Plan Commercial |
$13.03
|
| Rate for Payer: Cigna of CA HMO |
$10.43
|
| Rate for Payer: Cigna of CA PPO |
$12.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$13.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.66
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$12.22
|
| Rate for Payer: Networks By Design Commercial |
$10.59
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.93
|
| Rate for Payer: Prime Health Services Commercial |
$13.85
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
