|
HC SACHFOOT, REPLACEMENT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L5971
|
| Hospital Charge Code |
915355971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.82 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$176.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.13
|
| Rate for Payer: Blue Shield of California Commercial |
$344.86
|
| Rate for Payer: Blue Shield of California EPN |
$216.72
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$281.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Riverside University Health System MISP |
$172.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC SACHFOOT, REPLACEMENT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L5971
|
| Hospital Charge Code |
905355971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.82 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$176.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.13
|
| Rate for Payer: Blue Shield of California Commercial |
$344.86
|
| Rate for Payer: Blue Shield of California EPN |
$216.72
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$281.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Riverside University Health System MISP |
$172.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC SACHFOOT, REPLACEMENT
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT L5971
|
| Hospital Charge Code |
905355971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Blue Shield of California Commercial |
$344.86
|
| Rate for Payer: Blue Shield of California EPN |
$216.72
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$273.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$253.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
IP
|
$41,679.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,335.80 |
| Max. Negotiated Rate |
$37,511.10 |
| Rate for Payer: Adventist Health Commercial |
$8,335.80
|
| Rate for Payer: Cash Price |
$18,755.55
|
| Rate for Payer: Central Health Plan Commercial |
$33,343.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,671.60
|
| Rate for Payer: EPIC Health Plan Senior |
$16,671.60
|
| Rate for Payer: Galaxy Health WC |
$35,427.15
|
| Rate for Payer: Global Benefits Group Commercial |
$25,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$37,511.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26,466.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24,590.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,335.80
|
| Rate for Payer: Multiplan Commercial |
$31,259.25
|
| Rate for Payer: Networks By Design Commercial |
$27,091.35
|
| Rate for Payer: Prime Health Services Commercial |
$35,427.15
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
OP
|
$41,679.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,069.82 |
| Max. Negotiated Rate |
$37,511.10 |
| Rate for Payer: Adventist Health Commercial |
$8,335.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$18,755.55
|
| Rate for Payer: Cash Price |
$18,755.55
|
| Rate for Payer: Cash Price |
$18,755.55
|
| Rate for Payer: Central Health Plan Commercial |
$33,343.20
|
| Rate for Payer: Cigna of CA HMO |
$26,674.56
|
| Rate for Payer: Cigna of CA PPO |
$30,842.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29,175.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$35,427.15
|
| Rate for Payer: Global Benefits Group Commercial |
$25,007.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$37,511.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26,466.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15,129.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,335.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$31,259.25
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$27,091.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$35,427.15
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25,007.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20,839.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC SACRAL AUGMENTATION UNILAT
|
Facility
|
IP
|
$22,450.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,490.00 |
| Max. Negotiated Rate |
$20,205.00 |
| Rate for Payer: Adventist Health Commercial |
$4,490.00
|
| Rate for Payer: Cash Price |
$10,102.50
|
| Rate for Payer: Central Health Plan Commercial |
$17,960.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,715.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,980.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,980.00
|
| Rate for Payer: Galaxy Health WC |
$19,082.50
|
| Rate for Payer: Global Benefits Group Commercial |
$13,470.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,205.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,255.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,245.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,490.00
|
| Rate for Payer: Multiplan Commercial |
$16,837.50
|
| Rate for Payer: Networks By Design Commercial |
$14,592.50
|
| Rate for Payer: Prime Health Services Commercial |
$19,082.50
|
|
|
HC SACRAL AUGMENTATION UNILAT
|
Facility
|
OP
|
$22,450.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,069.82 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,490.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$9,332.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$10,102.50
|
| Rate for Payer: Cash Price |
$10,102.50
|
| Rate for Payer: Cash Price |
$10,102.50
|
| Rate for Payer: Central Health Plan Commercial |
$17,960.00
|
| Rate for Payer: Cigna of CA HMO |
$14,368.00
|
| Rate for Payer: Cigna of CA PPO |
$16,613.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,715.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$19,082.50
|
| Rate for Payer: Global Benefits Group Commercial |
$13,470.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,205.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,255.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8,149.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,065.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,490.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$16,837.50
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$14,592.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$19,082.50
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,470.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,225.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
OP
|
$2,457.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,351.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,842.75
|
| 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 |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: Cigna of CA HMO |
$1,572.48
|
| Rate for Payer: Cigna of CA PPO |
$1,818.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,088.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,088.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,719.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,560.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$558.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,449.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,719.90
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
| Rate for Payer: Riverside University Health System MISP |
$982.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,228.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,088.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,088.45
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$491.40 |
| Max. Negotiated Rate |
$2,211.30 |
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,719.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: EPIC Health Plan Senior |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,211.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,560.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,449.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$1,842.75
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
IP
|
$1,247.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.40 |
| Max. Negotiated Rate |
$1,122.30 |
| Rate for Payer: Adventist Health Commercial |
$249.40
|
| Rate for Payer: Cash Price |
$561.15
|
| Rate for Payer: Central Health Plan Commercial |
$997.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$872.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$498.80
|
| Rate for Payer: Galaxy Health WC |
$1,059.95
|
| Rate for Payer: Global Benefits Group Commercial |
$748.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,122.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$791.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$735.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.40
|
| Rate for Payer: Multiplan Commercial |
$935.25
|
| Rate for Payer: Networks By Design Commercial |
$810.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.95
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$1,122.30 |
| Rate for Payer: Adventist Health Commercial |
$249.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.14
|
| Rate for Payer: Blue Shield of California Commercial |
$785.61
|
| Rate for Payer: Blue Shield of California EPN |
$495.06
|
| Rate for Payer: Cash Price |
$561.15
|
| Rate for Payer: Cash Price |
$561.15
|
| Rate for Payer: Central Health Plan Commercial |
$997.60
|
| Rate for Payer: Cigna of CA HMO |
$798.08
|
| Rate for Payer: Cigna of CA PPO |
$922.78
|
| 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 |
$872.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,059.95
|
| Rate for Payer: Global Benefits Group Commercial |
$748.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,122.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$791.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$56.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$935.25
|
| Rate for Payer: Networks By Design Commercial |
$810.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.95
|
| 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 |
$748.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$748.20
|
| 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 SACRUM AND COCCYX
|
Facility
|
IP
|
$1,151.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$230.20 |
| Max. Negotiated Rate |
$1,035.90 |
| Rate for Payer: Adventist Health Commercial |
$230.20
|
| Rate for Payer: Cash Price |
$517.95
|
| Rate for Payer: Central Health Plan Commercial |
$920.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$805.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.40
|
| Rate for Payer: EPIC Health Plan Senior |
$460.40
|
| Rate for Payer: Galaxy Health WC |
$978.35
|
| Rate for Payer: Global Benefits Group Commercial |
$690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$730.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$679.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.20
|
| Rate for Payer: Multiplan Commercial |
$863.25
|
| Rate for Payer: Networks By Design Commercial |
$748.15
|
| Rate for Payer: Prime Health Services Commercial |
$978.35
|
|
|
HC SACRUM AND COCCYX
|
Facility
|
OP
|
$1,151.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.03 |
| Max. Negotiated Rate |
$1,035.90 |
| Rate for Payer: Adventist Health Commercial |
$230.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.05
|
| Rate for Payer: Blue Shield of California Commercial |
$725.13
|
| Rate for Payer: Blue Shield of California EPN |
$456.95
|
| Rate for Payer: Cash Price |
$517.95
|
| Rate for Payer: Cash Price |
$517.95
|
| Rate for Payer: Central Health Plan Commercial |
$920.80
|
| Rate for Payer: Cigna of CA HMO |
$736.64
|
| Rate for Payer: Cigna of CA PPO |
$851.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$805.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$978.35
|
| Rate for Payer: Global Benefits Group Commercial |
$690.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,035.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$730.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$863.25
|
| Rate for Payer: Networks By Design Commercial |
$748.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$978.35
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$690.60
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC SAFETY PIN SPRING WIRE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Blue Shield of California Commercial |
$116.29
|
| Rate for Payer: Blue Shield of California EPN |
$73.08
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$101.50
|
| Rate for Payer: Cigna of CA PPO |
$101.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$101.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.42
|
| Rate for Payer: United Healthcare All Other HMO |
$52.97
|
| Rate for Payer: United Healthcare HMO Rider |
$51.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.49
|
|
|
HC SAFETY PIN SPRING WIRE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.49 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$59.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$79.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.35
|
| Rate for Payer: Blue Shield of California Commercial |
$116.29
|
| Rate for Payer: Blue Shield of California EPN |
$73.08
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$101.50
|
| Rate for Payer: Cigna of CA PPO |
$101.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$123.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$101.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$92.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$85.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.50
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$72.50
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Riverside University Health System MISP |
$58.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$54.42
|
| Rate for Payer: United Healthcare All Other HMO |
$52.97
|
| Rate for Payer: United Healthcare HMO Rider |
$51.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$123.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
|
|
HC SALICYLATES
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$101.60 |
| Max. Negotiated Rate |
$457.20 |
| Rate for Payer: Adventist Health Commercial |
$101.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Central Health Plan Commercial |
$406.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$355.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$203.20
|
| Rate for Payer: EPIC Health Plan Senior |
$203.20
|
| Rate for Payer: Galaxy Health WC |
$431.80
|
| Rate for Payer: Global Benefits Group Commercial |
$304.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$457.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$322.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.60
|
| Rate for Payer: Multiplan Commercial |
$381.00
|
| Rate for Payer: Networks By Design Commercial |
$330.20
|
| Rate for Payer: Prime Health Services Commercial |
$431.80
|
|
|
HC SALICYLATES
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$623.23 |
| Rate for Payer: Adventist Health Commercial |
$101.60
|
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$623.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$623.23
|
| Rate for Payer: Blue Shield of California Commercial |
$51.66
|
| Rate for Payer: Blue Shield of California Commercial |
$320.04
|
| Rate for Payer: Blue Shield of California EPN |
$32.55
|
| Rate for Payer: Blue Shield of California EPN |
$201.68
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Cash Price |
$228.60
|
| Rate for Payer: Central Health Plan Commercial |
$406.40
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA HMO |
$325.12
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Cigna of CA PPO |
$375.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$355.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Galaxy Health WC |
$431.80
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Global Benefits Group Commercial |
$304.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$457.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$322.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$381.00
|
| Rate for Payer: Networks By Design Commercial |
$330.20
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$62.14
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Commercial |
$431.80
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$304.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SALIVARY DUCT DILATOR
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909081730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$45.95
|
| Rate for Payer: Blue Shield of California Commercial |
$50.09
|
| Rate for Payer: Blue Shield of California EPN |
$31.52
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55.30
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Riverside University Health System MISP |
$31.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC SALIVARY DUCT DILATOR
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909081730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Adventist Health Commercial |
$15.80
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Senior |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC SALIVARY GLAND
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
909001145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.64 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.04
|
| Rate for Payer: Blue Shield of California Commercial |
$197.82
|
| Rate for Payer: Blue Shield of California EPN |
$124.66
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: Cigna of CA HMO |
$200.96
|
| Rate for Payer: Cigna of CA PPO |
$232.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$199.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$52.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$188.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$188.40
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC SALIVARY GLAND
|
Facility
|
IP
|
$314.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
909001145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.80 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$219.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.60
|
| Rate for Payer: EPIC Health Plan Senior |
$125.60
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$199.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
|
|
HC SALIV (PAROTID) SCAN
|
Facility
|
IP
|
$1,113.00
|
|
|
Service Code
|
CPT 78230
|
| Hospital Charge Code |
909301355
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$1,001.70 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Cash Price |
$500.85
|
| Rate for Payer: Central Health Plan Commercial |
$890.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$779.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.20
|
| Rate for Payer: EPIC Health Plan Senior |
$445.20
|
| Rate for Payer: Galaxy Health WC |
$946.05
|
| Rate for Payer: Global Benefits Group Commercial |
$667.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$706.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$656.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.60
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
| Rate for Payer: Networks By Design Commercial |
$723.45
|
| Rate for Payer: Prime Health Services Commercial |
$946.05
|
|
|
HC SALIV (PAROTID) SCAN
|
Facility
|
OP
|
$1,113.00
|
|
|
Service Code
|
CPT 78230
|
| Hospital Charge Code |
909301355
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$104.21 |
| Max. Negotiated Rate |
$1,001.70 |
| Rate for Payer: Adventist Health Commercial |
$222.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$911.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$453.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.43
|
| Rate for Payer: Blue Shield of California Commercial |
$701.19
|
| Rate for Payer: Blue Shield of California EPN |
$441.86
|
| Rate for Payer: Cash Price |
$500.85
|
| Rate for Payer: Cash Price |
$500.85
|
| Rate for Payer: Central Health Plan Commercial |
$890.40
|
| Rate for Payer: Cigna of CA HMO |
$712.32
|
| Rate for Payer: Cigna of CA PPO |
$823.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$779.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$946.05
|
| Rate for Payer: Global Benefits Group Commercial |
$667.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$706.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$115.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$834.75
|
| Rate for Payer: Networks By Design Commercial |
$723.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$946.05
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$667.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$667.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC SARS-COV2-2 RNA POC
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912260
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$364.89 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$364.89
|
| Rate for Payer: Blue Shield of California Commercial |
$112.14
|
| Rate for Payer: Blue Shield of California Commercial |
$84.42
|
| Rate for Payer: Blue Shield of California EPN |
$70.67
|
| Rate for Payer: Blue Shield of California EPN |
$53.20
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SARS-COV2-2 RNA POC
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912260
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
