|
HC SLING ULTRASLING LARGE
|
Facility
|
OP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606213
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Adventist Health Commercial |
$115.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.87
|
| Rate for Payer: Blue Shield of California Commercial |
$142.28
|
| Rate for Payer: Blue Shield of California Commercial |
$215.80
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.44
|
| Rate for Payer: Multiplan Commercial |
$224.50
|
| Rate for Payer: Networks By Design Commercial |
$140.31
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.54
|
| Rate for Payer: Vantage Medical Group Senior |
$238.54
|
|
|
HC SLING ULTRASLING MED
|
Facility
|
IP
|
$283.43
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$56.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$127.54
|
| Rate for Payer: Cash Price |
$127.54
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$198.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.37
|
| Rate for Payer: EPIC Health Plan Senior |
$113.37
|
| Rate for Payer: Galaxy Health WC |
$240.92
|
| Rate for Payer: Global Benefits Group Commercial |
$170.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.02
|
| Rate for Payer: Multiplan Commercial |
$226.74
|
| Rate for Payer: Networks By Design Commercial |
$184.23
|
| Rate for Payer: Prime Health Services Commercial |
$240.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.37
|
| Rate for Payer: United Healthcare All Other HMO |
$103.54
|
| Rate for Payer: United Healthcare HMO Rider |
$101.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.82
|
|
|
HC SLING ULTRASLING MED
|
Facility
|
OP
|
$283.43
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$68.02 |
| Max. Negotiated Rate |
$240.92 |
| Rate for Payer: EPIC Health Plan Commercial |
$113.37
|
| Rate for Payer: EPIC Health Plan Senior |
$113.37
|
| Rate for Payer: Galaxy Health WC |
$240.92
|
| Rate for Payer: Adventist Health Commercial |
$116.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$240.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$212.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.56
|
| Rate for Payer: Blue Shield of California Commercial |
$143.70
|
| Rate for Payer: Blue Shield of California Commercial |
$217.96
|
| Rate for Payer: Cash Price |
$127.54
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$198.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$240.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$240.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$240.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$179.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$198.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$198.40
|
| Rate for Payer: Multiplan Commercial |
$226.74
|
| Rate for Payer: Networks By Design Commercial |
$141.72
|
| Rate for Payer: Prime Health Services Commercial |
$240.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.37
|
| Rate for Payer: United Healthcare All Other HMO |
$103.54
|
| Rate for Payer: United Healthcare HMO Rider |
$101.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$240.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$240.92
|
| Rate for Payer: Vantage Medical Group Senior |
$240.92
|
|
|
HC SLING ULTRASLING SMALL
|
Facility
|
IP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606212
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.13 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$56.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.35
|
| Rate for Payer: Multiplan Commercial |
$224.50
|
| Rate for Payer: Networks By Design Commercial |
$182.41
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
|
|
HC SLING ULTRASLING SMALL
|
Facility
|
OP
|
$280.63
|
|
|
Service Code
|
CPT A4565
|
| Hospital Charge Code |
901606212
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$67.35 |
| Max. Negotiated Rate |
$238.54 |
| Rate for Payer: Adventist Health Commercial |
$115.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$154.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$210.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.87
|
| Rate for Payer: Blue Shield of California Commercial |
$142.28
|
| Rate for Payer: Blue Shield of California Commercial |
$215.80
|
| Rate for Payer: Cash Price |
$126.28
|
| Rate for Payer: Cigna of CA HMO |
$196.44
|
| Rate for Payer: Cigna of CA PPO |
$196.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$238.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$238.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$238.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$196.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.25
|
| Rate for Payer: EPIC Health Plan Senior |
$112.25
|
| Rate for Payer: Galaxy Health WC |
$238.54
|
| Rate for Payer: Global Benefits Group Commercial |
$168.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$178.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$165.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$196.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$196.44
|
| Rate for Payer: Multiplan Commercial |
$224.50
|
| Rate for Payer: Networks By Design Commercial |
$140.31
|
| Rate for Payer: Prime Health Services Commercial |
$238.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$168.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$168.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$105.32
|
| Rate for Payer: United Healthcare All Other HMO |
$102.51
|
| Rate for Payer: United Healthcare HMO Rider |
$100.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$238.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$238.54
|
| Rate for Payer: Vantage Medical Group Senior |
$238.54
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
IP
|
$8,378.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,675.60 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Adventist Health Commercial |
$1,675.60
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,864.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,351.20
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,320.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,943.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
OP
|
$8,378.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Adventist Health Commercial |
$1,675.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cigna of CA HMO |
$5,361.92
|
| Rate for Payer: Cigna of CA PPO |
$6,199.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,864.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,320.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,026.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,189.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,189.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,189.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,189.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
OP
|
$8,378.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Adventist Health Commercial |
$3,434.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$994.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Cigna of CA HMO |
$5,361.92
|
| Rate for Payer: Cigna of CA PPO |
$6,199.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,864.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,320.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,026.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,026.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
IP
|
$8,378.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,675.60 |
| Max. Negotiated Rate |
$7,121.30 |
| Rate for Payer: Adventist Health Commercial |
$1,675.60
|
| Rate for Payer: Cash Price |
$3,770.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,864.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,351.20
|
| Rate for Payer: Galaxy Health WC |
$7,121.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,026.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,320.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,943.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.72
|
| Rate for Payer: Multiplan Commercial |
$6,702.40
|
| Rate for Payer: Networks By Design Commercial |
$5,445.70
|
| Rate for Payer: Prime Health Services Commercial |
$7,121.30
|
|
|
HC SLOW ACTIVATION
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.98
|
| Rate for Payer: Blue Shield of California Commercial |
$29.50
|
| Rate for Payer: Blue Shield of California Commercial |
$112.91
|
| Rate for Payer: Blue Shield of California Commercial |
$44.61
|
| Rate for Payer: Blue Shield of California Commercial |
$74.68
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA HMO |
$103.68
|
| Rate for Payer: Cigna of CA PPO |
$119.88
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.92
|
| Rate for Payer: EPIC Health Plan Senior |
$6.61
|
| Rate for Payer: EPIC Health Plan Senior |
$6.61
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC SLOW ACTIVATION
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.88
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
IP
|
$23,711.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$4,742.20 |
| Max. Negotiated Rate |
$20,154.35 |
| Rate for Payer: Adventist Health Commercial |
$4,742.20
|
| Rate for Payer: Blue Shield of California Commercial |
$12,021.48
|
| Rate for Payer: Blue Shield of California Commercial |
$18,233.76
|
| Rate for Payer: Cash Price |
$10,669.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,597.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,484.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,484.40
|
| Rate for Payer: Galaxy Health WC |
$20,154.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,226.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,056.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,989.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,690.64
|
| Rate for Payer: Multiplan Commercial |
$18,968.80
|
| Rate for Payer: Networks By Design Commercial |
$15,412.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,154.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,898.74
|
| Rate for Payer: United Healthcare All Other HMO |
$8,661.63
|
| Rate for Payer: United Healthcare HMO Rider |
$8,474.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,765.35
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
OP
|
$23,711.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$3,159.80 |
| Max. Negotiated Rate |
$112,749.04 |
| Rate for Payer: Adventist Health Commercial |
$4,742.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112,749.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,949.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,475.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,475.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,374.12
|
| Rate for Payer: Blue Shield of California Commercial |
$15,127.62
|
| Rate for Payer: Blue Shield of California Commercial |
$9,982.33
|
| Rate for Payer: Cash Price |
$10,669.95
|
| Rate for Payer: Cash Price |
$10,669.95
|
| Rate for Payer: Cigna of CA HMO |
$15,175.04
|
| Rate for Payer: Cigna of CA PPO |
$17,546.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,949.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,475.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,475.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16,597.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,213.67
|
| Rate for Payer: EPIC Health Plan Senior |
$3,475.78
|
| Rate for Payer: Galaxy Health WC |
$20,154.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14,226.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,182.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,362.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,159.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15,056.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30,945.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,423.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,690.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,981.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,234.13
|
| Rate for Payer: Multiplan Commercial |
$18,968.80
|
| Rate for Payer: Networks By Design Commercial |
$15,412.15
|
| Rate for Payer: Prime Health Services Commercial |
$20,154.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,226.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,226.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,898.74
|
| Rate for Payer: United Healthcare All Other HMO |
$8,661.63
|
| Rate for Payer: United Healthcare HMO Rider |
$8,474.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,765.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,159.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,949.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,475.78
|
| Rate for Payer: Vantage Medical Group Senior |
$3,475.78
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
OP
|
$1,745.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.96 |
| Max. Negotiated Rate |
$1,483.25 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$601.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$384.83
|
| Rate for Payer: Blue Shield of California Commercial |
$1,113.31
|
| Rate for Payer: Blue Shield of California Commercial |
$734.64
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Cigna of CA HMO |
$1,116.80
|
| Rate for Payer: Cigna of CA PPO |
$1,291.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,221.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$158.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,108.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$179.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,396.00
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,047.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
IP
|
$1,745.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$349.00 |
| Max. Negotiated Rate |
$1,483.25 |
| Rate for Payer: Adventist Health Commercial |
$349.00
|
| Rate for Payer: Cash Price |
$785.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,221.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.00
|
| Rate for Payer: EPIC Health Plan Senior |
$698.00
|
| Rate for Payer: Galaxy Health WC |
$1,483.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,108.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,029.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.80
|
| Rate for Payer: Multiplan Commercial |
$1,396.00
|
| Rate for Payer: Networks By Design Commercial |
$1,134.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,483.25
|
|
|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| 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: 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
|
|
|
HC SMALLPOX AND MONKEYPOX VAC 0.5ML SUBQ
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT 90611
|
| Hospital Charge Code |
948000200
|
|
Hospital Revenue Code
|
636
|
| Max. Negotiated Rate |
$1,914.64 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,914.64
|
| 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 HMO/PPO |
$0.17
|
| Rate for Payer: Blue Shield of California Commercial |
$324.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.02
|
| Rate for Payer: EPIC Health Plan Senior |
$0.01
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$0.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$479.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$541.99
|
| Rate for Payer: Kaiser Foundation Hospitals 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: 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: Upland Medical Group Pediatric |
$0.01
|
| 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
|
|
|
HC SMIC/ID
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.32
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SMIC/ID
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC SMITHAB
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913711
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$18.70 |
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8.80
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
|
|
HC SMITHAB
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913711
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$157.18 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Adventist Health Commercial |
$4.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.18
|
| Rate for Payer: Blue Shield of California Commercial |
$10.14
|
| Rate for Payer: Blue Shield of California Commercial |
$12.55
|
| Rate for Payer: Blue Shield of California Commercial |
$15.33
|
| Rate for Payer: Blue Shield of California Commercial |
$8.30
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SMOKING CESSATION 3 - 10 MIN
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.49 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna of CA HMO |
$62.72
|
| Rate for Payer: Cigna of CA PPO |
$72.52
|
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.89
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.00
|
| Rate for Payer: United Healthcare All Other HMO |
$49.00
|
| Rate for Payer: United Healthcare HMO Rider |
$49.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
|
HC SMOKING CESSATION 3 - 10 MIN
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$83.30 |
| Rate for Payer: Adventist Health Commercial |
$19.60
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Senior |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.52
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$135.15 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$111.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Senior |
$63.60
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.16
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$33.48 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$65.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$161.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.03
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cigna of CA HMO |
$101.76
|
| Rate for Payer: Cigna of CA PPO |
$117.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$111.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.51
|
| Rate for Payer: EPIC Health Plan Senior |
$53.01
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$79.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.57
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.01
|
| Rate for Payer: Vantage Medical Group Senior |
$48.19
|
|
