|
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 |
$22,923.45
|
| Rate for Payer: Central Health Plan Commercial |
$33,343.20
|
| 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 Permanente of CA Commercial/Self Funded |
$27,799.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,879.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25,799.30
|
| 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 |
$9,076.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$22,923.45
|
| Rate for Payer: Cash Price |
$22,923.45
|
| Rate for Payer: Cash Price |
$22,923.45
|
| 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 |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| 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 |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27,799.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15,879.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,335.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| 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 |
$9,076.82
|
| 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 |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25,007.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| 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 |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
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 |
$12,347.50
|
| Rate for Payer: Central Health Plan Commercial |
$17,960.00
|
| 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 Permanente of CA Commercial/Self Funded |
$14,974.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,553.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,896.55
|
| 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 |
$9,076.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$12,347.50
|
| Rate for Payer: Cash Price |
$12,347.50
|
| Rate for Payer: Cash Price |
$12,347.50
|
| 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 |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| 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 |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,974.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,553.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,490.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| 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 |
$9,076.82
|
| 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 |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,470.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| 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 |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
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 |
$1,351.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,965.60
|
| 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 Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.88
|
| 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 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$491.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cash Price |
$1,351.35
|
| Rate for Payer: Cash Price |
$1,351.35
|
| 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: 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: InnovAge PACE Commercial |
$1,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,719.90
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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 SACRO ILIAC JOINTS
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.15 |
| Max. Negotiated Rate |
$1,122.30 |
| Rate for Payer: Adventist Health Commercial |
$249.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$757.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.15
|
| Rate for Payer: Blue Shield of California Commercial |
$756.93
|
| Rate for Payer: Blue Shield of California EPN |
$495.06
|
| Rate for Payer: Cash Price |
$685.85
|
| Rate for Payer: Cash Price |
$685.85
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,059.95
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$935.25
|
| Rate for Payer: Networks By Design Commercial |
$810.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.95
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC 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 |
$685.85
|
| Rate for Payer: Central Health Plan Commercial |
$997.60
|
| 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 Permanente of CA Commercial/Self Funded |
$831.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.89
|
| 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 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 |
$633.05
|
| Rate for Payer: Central Health Plan Commercial |
$920.80
|
| 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 Permanente of CA Commercial/Self Funded |
$767.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$712.47
|
| 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 |
$24.09 |
| Max. Negotiated Rate |
$1,035.90 |
| Rate for Payer: Adventist Health Commercial |
$230.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$699.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.09
|
| Rate for Payer: Blue Shield of California Commercial |
$698.66
|
| Rate for Payer: Blue Shield of California EPN |
$456.95
|
| Rate for Payer: Cash Price |
$633.05
|
| Rate for Payer: Cash Price |
$633.05
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$767.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$863.25
|
| Rate for Payer: Networks By Design Commercial |
$748.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$978.35
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$690.60
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC 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 |
$85.16
|
| Rate for Payer: Blue Shield of California Commercial |
$112.08
|
| Rate for Payer: Blue Shield of California EPN |
$73.08
|
| Rate for Payer: Cash Price |
$79.75
|
| Rate for Payer: Cash Price |
$79.75
|
| 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: 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: InnovAge PACE Commercial |
$72.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.50
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$112.08
|
| Rate for Payer: Blue Shield of California EPN |
$73.08
|
| Rate for Payer: Cash Price |
$79.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| 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 SALICYLATES
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC SALICYLATES
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$448.29 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| 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 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 HMO/PPO |
$90.98
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California EPN |
$32.55
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Senior |
$62.14
|
| 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: 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) Medicare Advantage |
$62.14
|
| Rate for Payer: InnovAge PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| 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 Medicare |
$65.87
|
| Rate for Payer: Riverside University Health System MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 Select/Navigate/Core |
$50.34
|
| 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 Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
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 |
$43.45
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| 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 Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| 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 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 |
$46.40
|
| Rate for Payer: Blue Shield of California Commercial |
$48.27
|
| Rate for Payer: Blue Shield of California EPN |
$31.52
|
| Rate for Payer: Cash Price |
$43.45
|
| 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: 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: InnovAge PACE Commercial |
$39.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$48.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$55.30
|
| Rate for Payer: Molina Healthcare of CA 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 GLAND
|
Facility
|
OP
|
$314.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
909001145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.18 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Adventist Health Commercial |
$62.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.18
|
| Rate for Payer: Blue Shield of California Commercial |
$190.60
|
| Rate for Payer: Blue Shield of California EPN |
$124.66
|
| Rate for Payer: Cash Price |
$172.70
|
| Rate for Payer: Cash Price |
$172.70
|
| 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 |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$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 |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC 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 |
$172.70
|
| Rate for Payer: Central Health Plan Commercial |
$251.20
|
| 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 Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.37
|
| 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 |
$612.15
|
| Rate for Payer: Central Health Plan Commercial |
$890.40
|
| 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 Permanente of CA Commercial/Self Funded |
$742.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$688.95
|
| 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 |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$675.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$453.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$653.66
|
| Rate for Payer: Blue Shield of California Commercial |
$675.59
|
| Rate for Payer: Blue Shield of California EPN |
$441.86
|
| Rate for Payer: Cash Price |
$612.15
|
| Rate for Payer: Cash Price |
$612.15
|
| 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 |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| 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 |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$104.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$742.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| 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 |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$946.05
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| 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 |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
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 |
$262.47 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| 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 Medi-Cal |
$56.44
|
| 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 HMO/PPO |
$53.27
|
| Rate for Payer: Blue Shield of California Commercial |
$81.34
|
| Rate for Payer: Blue Shield of California EPN |
$53.20
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| 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) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| 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 HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| 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 Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SARS-COV2-2 RNA POC
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900912260
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC SARS-COV-2 BY AUTOMATED PCR
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913687
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$41.56 |
| Max. Negotiated Rate |
$262.47 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| 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 Medi-Cal |
$56.44
|
| 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 HMO/PPO |
$53.27
|
| Rate for Payer: Blue Shield of California Commercial |
$155.39
|
| Rate for Payer: Blue Shield of California EPN |
$101.63
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Central Health Plan Commercial |
$204.80
|
| Rate for Payer: Cigna of CA HMO |
$163.84
|
| Rate for Payer: Cigna of CA PPO |
$189.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$217.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.40
|
| 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) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$166.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$217.60
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.60
|
| 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 HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| 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 Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC SARS-COV-2 BY AUTOMATED PCR
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913687
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$51.20 |
| Max. Negotiated Rate |
$230.40 |
| Rate for Payer: Adventist Health Commercial |
$51.20
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Central Health Plan Commercial |
$204.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.40
|
| Rate for Payer: EPIC Health Plan Senior |
$102.40
|
| Rate for Payer: Galaxy Health WC |
$217.60
|
| Rate for Payer: Global Benefits Group Commercial |
$153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Networks By Design Commercial |
$166.40
|
| Rate for Payer: Prime Health Services Commercial |
$217.60
|
|
|
HC SARSCOV2 MOD BV BOOSTER 50MCG/0.5ML
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 91313
|
| Hospital Charge Code |
949001349
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.02 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Cash Price |
$0.01
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: InnovAge PACE Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.00
|
| Rate for Payer: United Healthcare All Other HMO |
$0.00
|
| Rate for Payer: United Healthcare HMO Rider |
$0.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
