|
HC RUBELLA ANTIBODY IGG QUANT
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC RUBELLA ANTIBODY IGG QUANT
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$127.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$127.31
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$14.39
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Media |
$14.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: InnovAge PACE Commercial |
$21.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$15.25
|
| Rate for Payer: Riverside University Health System MISP |
$15.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC RUBEOLA ANTIBODY
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC RUBEOLA ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$114.34 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.34
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.95
|
| Rate for Payer: Caremore Medicare Advantage |
$12.88
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Central Health Plan Commercial |
$31.20
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Media |
$12.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: InnovAge PACE Commercial |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$29.25
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Medicare |
$13.65
|
| Rate for Payer: Riverside University Health System MISP |
$14.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC RYE IGE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: Blue Distinction Transplant |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$39.55
|
| Rate for Payer: Blue Shield of California EPN |
$31.10
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Media |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC RYE IGE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913639
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
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: Blue Shield of California EPN |
$229.62
|
| 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: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| 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 |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.37
|
| Rate for Payer: United Healthcare All Other HMO |
$158.58
|
| Rate for Payer: United Healthcare HMO Rider |
$155.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.90
|
|
|
HC SACHFOOT, REPLACEMENT
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L5971
|
| Hospital Charge Code |
905355971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$387.00 |
| 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 |
$236.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.04
|
| Rate for Payer: Blue Distinction Transplant |
$258.00
|
| Rate for Payer: Blue Shield of California Commercial |
$322.50
|
| Rate for Payer: Blue Shield of California EPN |
$233.92
|
| 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 Media |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$322.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$311.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.30
|
| 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 |
$215.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$215.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
IP
|
$31,516.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,303.20 |
| Max. Negotiated Rate |
$28,364.40 |
| Rate for Payer: Cash Price |
$14,182.20
|
| Rate for Payer: Central Health Plan Commercial |
$25,212.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,606.40
|
| Rate for Payer: Galaxy Health WC |
$26,788.60
|
| Rate for Payer: Global Benefits Group Commercial |
$18,909.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,364.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,021.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,007.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,303.20
|
| Rate for Payer: Multiplan Commercial |
$23,637.00
|
| Rate for Payer: Networks By Design Commercial |
$20,485.40
|
| Rate for Payer: Prime Health Services Commercial |
$26,788.60
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
OP
|
$31,516.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$28,364.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,135.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$18,909.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$14,182.20
|
| Rate for Payer: Cash Price |
$14,182.20
|
| Rate for Payer: Central Health Plan Commercial |
$25,212.80
|
| Rate for Payer: Cigna of CA PPO |
$23,321.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$26,788.60
|
| Rate for Payer: Global Benefits Group Commercial |
$18,909.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$28,364.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23,637.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,748.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,021.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,007.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,303.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$23,637.00
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$20,485.40
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$26,788.60
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,909.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC SACRAL AUGMENTATION UNILAT
|
Facility
|
IP
|
$16,976.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,395.20 |
| Max. Negotiated Rate |
$15,278.40 |
| Rate for Payer: Cash Price |
$7,639.20
|
| Rate for Payer: Central Health Plan Commercial |
$13,580.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,790.40
|
| Rate for Payer: Galaxy Health WC |
$14,429.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,185.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,278.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,322.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,467.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,395.20
|
| Rate for Payer: Multiplan Commercial |
$12,732.00
|
| Rate for Payer: Networks By Design Commercial |
$11,034.40
|
| Rate for Payer: Prime Health Services Commercial |
$14,429.60
|
|
|
HC SACRAL AUGMENTATION UNILAT
|
Facility
|
OP
|
$16,976.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,212.08 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8,938.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17,949.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$10,185.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$7,639.20
|
| Rate for Payer: Cash Price |
$7,639.20
|
| Rate for Payer: Central Health Plan Commercial |
$13,580.80
|
| Rate for Payer: Cigna of CA PPO |
$12,562.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$14,429.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,185.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,278.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,732.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14,748.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,322.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,467.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,395.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$12,732.00
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$11,034.40
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$14,429.60
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,185.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
IP
|
$2,514.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$502.80 |
| Max. Negotiated Rate |
$2,262.60 |
| Rate for Payer: Cash Price |
$1,131.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,011.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,005.60
|
| Rate for Payer: Galaxy Health WC |
$2,136.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,262.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,676.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$957.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.80
|
| Rate for Payer: Multiplan Commercial |
$1,885.50
|
| Rate for Payer: Networks By Design Commercial |
$1,634.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,136.90
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
OP
|
$2,514.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$502.80 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,136.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,382.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,382.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,508.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Cash Price |
$1,131.30
|
| Rate for Payer: Cash Price |
$1,131.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,011.20
|
| Rate for Payer: Cigna of CA PPO |
$1,860.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,136.90
|
| Rate for Payer: Dignity Health Media |
$2,136.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,136.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,005.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,005.60
|
| Rate for Payer: Galaxy Health WC |
$2,136.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,508.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,262.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,885.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$879.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,676.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.80
|
| Rate for Payer: Multiplan Commercial |
$1,885.50
|
| Rate for Payer: Networks By Design Commercial |
$1,634.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,136.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,005.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,508.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,136.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,136.90
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
IP
|
$1,123.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$224.60 |
| Max. Negotiated Rate |
$1,010.70 |
| Rate for Payer: Cash Price |
$505.35
|
| Rate for Payer: Central Health Plan Commercial |
$898.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$449.20
|
| Rate for Payer: Galaxy Health WC |
$954.55
|
| Rate for Payer: Global Benefits Group Commercial |
$673.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,010.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$749.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.60
|
| Rate for Payer: Multiplan Commercial |
$842.25
|
| Rate for Payer: Networks By Design Commercial |
$729.95
|
| Rate for Payer: Prime Health Services Commercial |
$954.55
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
OP
|
$1,123.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$1,010.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Blue Distinction Transplant |
$673.80
|
| Rate for Payer: Blue Shield of California Commercial |
$694.01
|
| Rate for Payer: Blue Shield of California EPN |
$545.78
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$505.35
|
| Rate for Payer: Cash Price |
$505.35
|
| Rate for Payer: Central Health Plan Commercial |
$898.40
|
| Rate for Payer: Cigna of CA HMO |
$718.72
|
| Rate for Payer: Cigna of CA PPO |
$831.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$954.55
|
| Rate for Payer: Global Benefits Group Commercial |
$673.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,010.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$842.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$749.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$842.25
|
| Rate for Payer: Networks By Design Commercial |
$729.95
|
| Rate for Payer: Prime Health Services Commercial |
$954.55
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$673.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$673.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SACRUM AND COCCYX
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.54 |
| Max. Negotiated Rate |
$933.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.81
|
| Rate for Payer: Blue Distinction Transplant |
$622.20
|
| Rate for Payer: Blue Shield of California Commercial |
$640.87
|
| Rate for Payer: Blue Shield of California EPN |
$503.98
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Central Health Plan Commercial |
$829.60
|
| Rate for Payer: Cigna of CA HMO |
$663.68
|
| Rate for Payer: Cigna of CA PPO |
$767.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$933.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$777.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$622.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$622.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SACRUM AND COCCYX
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$933.30 |
| Rate for Payer: Cash Price |
$466.65
|
| Rate for Payer: Central Health Plan Commercial |
$829.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.80
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$933.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$395.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.40
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
|
|
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: Blue Shield of California EPN |
$77.43
|
| 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: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$29.00
|
| 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: United Healthcare All Other Commercial |
$54.75
|
| Rate for Payer: United Healthcare All Other HMO |
$53.48
|
| Rate for Payer: United Healthcare HMO Rider |
$52.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.85
|
|
|
HC SAFETY PIN SPRING WIRE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
903203932
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.75 |
| Max. Negotiated Rate |
$130.50 |
| 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 |
$79.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$70.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.67
|
| Rate for Payer: Blue Distinction Transplant |
$87.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.75
|
| Rate for Payer: Blue Shield of California EPN |
$78.88
|
| 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 Media |
$123.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$108.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.45
|
| 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 |
$72.50
|
| Rate for Payer: United Healthcare All Other HMO |
$72.50
|
| Rate for Payer: United Healthcare HMO Rider |
$72.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.25
|
| Rate for Payer: Vantage Medical Group Senior |
$123.25
|
|
|
HC SALICYLATES
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$546.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| 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 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 |
$546.80
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Media |
$62.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$102.53
|
| 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 |
$20.68
|
| 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 |
$6.20
|
| 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 |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| 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 |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| 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: 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 SALICYLATES
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
|
|
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: 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 |
$43.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.67
|
| Rate for Payer: Blue Distinction Transplant |
$47.40
|
| Rate for Payer: Blue Shield of California Commercial |
$49.69
|
| Rate for Payer: Blue Shield of California EPN |
$38.63
|
| 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 Media |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$59.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.65
|
| 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: 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
|
| 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 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: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 |
$52.63 |
| Max. Negotiated Rate |
$282.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.36
|
| Rate for Payer: Blue Distinction Transplant |
$188.40
|
| Rate for Payer: Blue Shield of California Commercial |
$194.05
|
| Rate for Payer: Blue Shield of California EPN |
$152.60
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| 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 |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$266.90
|
| Rate for Payer: Global Benefits Group Commercial |
$188.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$282.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$235.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$209.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$235.50
|
| Rate for Payer: Networks By Design Commercial |
$204.10
|
| Rate for Payer: Prime Health Services Commercial |
$266.90
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
