|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$683.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$550.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$550.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$714.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$590.80
|
| Rate for Payer: Blue Distinction Transplant |
$600.00
|
| Rate for Payer: Blue Shield of California Commercial |
$618.00
|
| Rate for Payer: Blue Shield of California EPN |
$486.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Central Health Plan Commercial |
$800.00
|
| Rate for Payer: Cigna of CA HMO |
$640.00
|
| Rate for Payer: Cigna of CA PPO |
$740.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.00
|
| Rate for Payer: Dignity Health Media |
$850.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$850.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.00
|
| Rate for Payer: Galaxy Health WC |
$850.00
|
| Rate for Payer: Global Benefits Group Commercial |
$600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$900.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$750.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$667.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.00
|
| Rate for Payer: Multiplan Commercial |
$750.00
|
| Rate for Payer: Networks By Design Commercial |
$650.00
|
| Rate for Payer: Prime Health Services Commercial |
$850.00
|
| Rate for Payer: Riverside University Health System MISP |
$400.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$600.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.54
|
| Rate for Payer: United Healthcare All Other HMO |
$321.54
|
| Rate for Payer: United Healthcare HMO Rider |
$321.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$850.00
|
| Rate for Payer: Vantage Medical Group Senior |
$850.00
|
|
|
HC MAMMOGRAPHY DIGITAL BILAT
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 77066
|
| Hospital Charge Code |
909002011
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$200.00 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Cash Price |
$450.00
|
| Rate for Payer: Central Health Plan Commercial |
$800.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.00
|
| Rate for Payer: Galaxy Health WC |
$850.00
|
| Rate for Payer: Global Benefits Group Commercial |
$600.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$900.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$667.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.00
|
| Rate for Payer: Multiplan Commercial |
$750.00
|
| Rate for Payer: Networks By Design Commercial |
$650.00
|
| Rate for Payer: Prime Health Services Commercial |
$850.00
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$155.20 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$534.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$558.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$458.46
|
| Rate for Payer: Blue Distinction Transplant |
$465.60
|
| Rate for Payer: Blue Shield of California Commercial |
$479.57
|
| Rate for Payer: Blue Shield of California EPN |
$377.14
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: Cigna of CA HMO |
$496.64
|
| Rate for Payer: Cigna of CA PPO |
$574.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$659.60
|
| Rate for Payer: Dignity Health Media |
$659.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$659.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$582.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$271.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$504.40
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: Riverside University Health System MISP |
$310.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.70
|
| Rate for Payer: United Healthcare All Other HMO |
$252.70
|
| Rate for Payer: United Healthcare HMO Rider |
$252.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$659.60
|
| Rate for Payer: Vantage Medical Group Senior |
$659.60
|
|
|
HC MAMMOGRAPHY DIGITAL UNILAT ALL VIEWS
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT 77065
|
| Hospital Charge Code |
909002012
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$155.20 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$504.40
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
OP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$505.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$708.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$458.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$403.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$492.14
|
| Rate for Payer: Blue Distinction Transplant |
$499.80
|
| Rate for Payer: Blue Shield of California Commercial |
$523.96
|
| Rate for Payer: Blue Shield of California EPN |
$407.34
|
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: Cigna of CA HMO |
$533.12
|
| Rate for Payer: Cigna of CA PPO |
$616.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$708.05
|
| Rate for Payer: Dignity Health Media |
$708.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$708.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$624.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$291.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
| Rate for Payer: Riverside University Health System MISP |
$333.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$499.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$499.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$416.50
|
| Rate for Payer: United Healthcare All Other HMO |
$416.50
|
| Rate for Payer: United Healthcare HMO Rider |
$416.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$416.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$708.05
|
| Rate for Payer: Vantage Medical Group Senior |
$708.05
|
|
|
HC MAMOTOME PROBE 11 GA
|
Facility
|
IP
|
$833.00
|
|
| Hospital Charge Code |
906601882
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Cash Price |
$374.85
|
| Rate for Payer: Central Health Plan Commercial |
$666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.20
|
| Rate for Payer: Galaxy Health WC |
$708.05
|
| Rate for Payer: Global Benefits Group Commercial |
$499.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$749.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$555.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$624.75
|
| Rate for Payer: Networks By Design Commercial |
$541.45
|
| Rate for Payer: Prime Health Services Commercial |
$708.05
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
IP
|
$1,613.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$322.60 |
| Max. Negotiated Rate |
$1,451.70 |
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,290.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$645.20
|
| Rate for Payer: Galaxy Health WC |
$1,371.05
|
| Rate for Payer: Global Benefits Group Commercial |
$967.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,451.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,075.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$614.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.60
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.05
|
|
|
HC MANDIBLE-COMPLETE
|
Facility
|
OP
|
$1,613.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
909001122
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$1,451.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.83
|
| Rate for Payer: Blue Distinction Transplant |
$967.80
|
| Rate for Payer: Blue Shield of California Commercial |
$996.83
|
| Rate for Payer: Blue Shield of California EPN |
$783.92
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Cash Price |
$725.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,290.40
|
| Rate for Payer: Cigna of CA HMO |
$1,032.32
|
| Rate for Payer: Cigna of CA PPO |
$1,193.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,371.05
|
| Rate for Payer: Global Benefits Group Commercial |
$967.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,451.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,209.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,075.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,209.75
|
| Rate for Payer: Networks By Design Commercial |
$1,048.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,371.05
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$967.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$967.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC MANDIBLE LIMITED
|
Facility
|
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
909001123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.69 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.44
|
| Rate for Payer: Blue Distinction Transplant |
$621.60
|
| Rate for Payer: Blue Shield of California Commercial |
$640.25
|
| Rate for Payer: Blue Shield of California EPN |
$503.50
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Central Health Plan Commercial |
$828.80
|
| Rate for Payer: Cigna of CA HMO |
$663.04
|
| Rate for Payer: Cigna of CA PPO |
$766.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$932.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$777.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$777.00
|
| Rate for Payer: Networks By Design Commercial |
$673.40
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC MANDIBLE LIMITED
|
Facility
|
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
909001123
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Central Health Plan Commercial |
$828.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.40
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$932.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$777.00
|
| Rate for Payer: Networks By Design Commercial |
$673.40
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
|
|
HC MANDIBLE-PANOREX
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
909001124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.48 |
| Max. Negotiated Rate |
$862.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.75
|
| Rate for Payer: Blue Distinction Transplant |
$574.80
|
| Rate for Payer: Blue Shield of California Commercial |
$592.04
|
| Rate for Payer: Blue Shield of California EPN |
$465.59
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Central Health Plan Commercial |
$766.40
|
| Rate for Payer: Cigna of CA HMO |
$613.12
|
| Rate for Payer: Cigna of CA PPO |
$708.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$814.30
|
| Rate for Payer: Global Benefits Group Commercial |
$574.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$862.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$718.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$718.50
|
| Rate for Payer: Networks By Design Commercial |
$622.70
|
| Rate for Payer: Prime Health Services Commercial |
$814.30
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.10
|
| Rate for Payer: United Healthcare All Other HMO |
$82.10
|
| Rate for Payer: United Healthcare HMO Rider |
$82.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC MANDIBLE-PANOREX
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
909001124
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.60 |
| Max. Negotiated Rate |
$862.20 |
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Central Health Plan Commercial |
$766.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.20
|
| Rate for Payer: Galaxy Health WC |
$814.30
|
| Rate for Payer: Global Benefits Group Commercial |
$574.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$862.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.60
|
| Rate for Payer: Multiplan Commercial |
$718.50
|
| Rate for Payer: Networks By Design Commercial |
$622.70
|
| Rate for Payer: Prime Health Services Commercial |
$814.30
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
901300057
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900400053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$182.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: Cigna of CA HMO |
$194.56
|
| Rate for Payer: Cigna of CA PPO |
$224.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.40
|
| Rate for Payer: Dignity Health Media |
$258.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.64
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
| Rate for Payer: Riverside University Health System MISP |
$121.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.40
|
| Rate for Payer: Vantage Medical Group Senior |
$258.40
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
901300057
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$182.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: Cigna of CA HMO |
$194.56
|
| Rate for Payer: Cigna of CA PPO |
$224.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.40
|
| Rate for Payer: Dignity Health Media |
$258.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.64
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
| Rate for Payer: Riverside University Health System MISP |
$121.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.40
|
| Rate for Payer: Vantage Medical Group Senior |
$258.40
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN MCAL
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900400053
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN OT
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905197140
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN OT
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905197140
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$182.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: Cigna of CA HMO |
$194.56
|
| Rate for Payer: Cigna of CA PPO |
$224.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.40
|
| Rate for Payer: Dignity Health Media |
$258.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.64
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
| Rate for Payer: Riverside University Health System MISP |
$121.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.40
|
| Rate for Payer: Vantage Medical Group Senior |
$258.40
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN PT
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900417140
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN PT
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905103160
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$182.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: Cigna of CA HMO |
$194.56
|
| Rate for Payer: Cigna of CA PPO |
$224.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.40
|
| Rate for Payer: Dignity Health Media |
$258.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.64
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
| Rate for Payer: Riverside University Health System MISP |
$121.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.40
|
| Rate for Payer: Vantage Medical Group Senior |
$258.40
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN PT
|
Facility
|
OP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
900417140
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.20 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$115.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$258.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$167.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$167.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$182.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: Cigna of CA HMO |
$194.56
|
| Rate for Payer: Cigna of CA PPO |
$224.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$258.40
|
| Rate for Payer: Dignity Health Media |
$258.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$258.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$228.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$106.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.64
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
| Rate for Payer: Riverside University Health System MISP |
$121.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$182.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$258.40
|
| Rate for Payer: Vantage Medical Group Senior |
$258.40
|
|
|
HC MANUAL THRPY TECHNIQUES 15 MIN PT
|
Facility
|
IP
|
$304.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
905103160
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.80 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Central Health Plan Commercial |
$243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.60
|
| Rate for Payer: Galaxy Health WC |
$258.40
|
| Rate for Payer: Global Benefits Group Commercial |
$182.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.80
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Networks By Design Commercial |
$197.60
|
| Rate for Payer: Prime Health Services Commercial |
$258.40
|
|
|
HC MARATHON LIQUID SKIN PROTECTANT
|
Facility
|
IP
|
$43.38
|
|
| Hospital Charge Code |
901607240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$39.04 |
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Central Health Plan Commercial |
$34.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.35
|
| Rate for Payer: Galaxy Health WC |
$36.87
|
| Rate for Payer: Global Benefits Group Commercial |
$26.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$28.20
|
| Rate for Payer: Prime Health Services Commercial |
$36.87
|
|
|
HC MARATHON LIQUID SKIN PROTECTANT
|
Facility
|
OP
|
$43.38
|
|
| Hospital Charge Code |
901607240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$39.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.63
|
| Rate for Payer: Blue Distinction Transplant |
$26.03
|
| Rate for Payer: Blue Shield of California Commercial |
$27.29
|
| Rate for Payer: Blue Shield of California EPN |
$21.21
|
| Rate for Payer: Cash Price |
$19.52
|
| Rate for Payer: Central Health Plan Commercial |
$34.70
|
| Rate for Payer: Cigna of CA HMO |
$27.76
|
| Rate for Payer: Cigna of CA PPO |
$32.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.87
|
| Rate for Payer: Dignity Health Media |
$36.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.35
|
| Rate for Payer: Galaxy Health WC |
$36.87
|
| Rate for Payer: Global Benefits Group Commercial |
$26.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.04
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.68
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$28.20
|
| Rate for Payer: Prime Health Services Commercial |
$36.87
|
| Rate for Payer: Riverside University Health System MISP |
$17.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.87
|
| Rate for Payer: Vantage Medical Group Senior |
$36.87
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
905353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Blue Shield of California EPN |
$43.79
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.96
|
| Rate for Payer: United Healthcare All Other HMO |
$30.24
|
| Rate for Payer: United Healthcare HMO Rider |
$29.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.06
|
|
