|
HC ADD VENOUS ABLATION SNGL EXTRE
|
Facility
|
IP
|
$9,361.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,246.64 |
| Max. Negotiated Rate |
$7,956.85 |
| Rate for Payer: Cash Price |
$4,212.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,744.40
|
| Rate for Payer: Galaxy Health WC |
$7,956.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,616.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,243.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,566.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,246.64
|
| Rate for Payer: Multiplan Commercial |
$7,488.80
|
| Rate for Payer: Networks By Design Commercial |
$6,084.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,956.85
|
|
|
HC ADD VENOUS ABLATION SNGL EXTRE
|
Facility
|
OP
|
$9,361.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.99 |
| Max. Negotiated Rate |
$7,956.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,956.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,148.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,148.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,616.60
|
| Rate for Payer: Blue Shield of California Commercial |
$5,803.51
|
| Rate for Payer: Blue Shield of California EPN |
$3,777.25
|
| Rate for Payer: Cash Price |
$4,212.45
|
| Rate for Payer: Cash Price |
$4,212.45
|
| Rate for Payer: Cigna of CA PPO |
$6,927.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,956.85
|
| Rate for Payer: Dignity Health Media |
$7,956.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,956.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,744.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,744.40
|
| Rate for Payer: Galaxy Health WC |
$7,956.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,616.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,020.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,243.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,246.64
|
| Rate for Payer: Multiplan Commercial |
$7,488.80
|
| Rate for Payer: Networks By Design Commercial |
$6,084.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,956.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,616.60
|
| 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 Commercial/Exchange |
$7,956.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,956.85
|
| Rate for Payer: Vantage Medical Group Senior |
$7,956.85
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
IP
|
$9,671.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,321.04 |
| Max. Negotiated Rate |
$8,220.35 |
| Rate for Payer: Cash Price |
$4,351.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,868.40
|
| Rate for Payer: Galaxy Health WC |
$8,220.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,802.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,450.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,684.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,321.04
|
| Rate for Payer: Multiplan Commercial |
$7,736.80
|
| Rate for Payer: Networks By Design Commercial |
$6,286.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,220.35
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
OP
|
$9,671.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$8,220.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,802.60
|
| Rate for Payer: Cash Price |
$4,351.95
|
| Rate for Payer: Cash Price |
$4,351.95
|
| Rate for Payer: Cash Price |
$4,351.95
|
| Rate for Payer: Cigna of CA PPO |
$7,156.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$8,220.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,802.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,253.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,450.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,321.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$7,736.80
|
| Rate for Payer: Networks By Design Commercial |
$6,286.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,220.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,802.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,835.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,835.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,835.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,835.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$2,096.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$503.04 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,248.80
|
| Rate for Payer: Blue Distinction Transplant |
$1,257.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cigna of CA PPO |
$1,551.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,781.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,572.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,676.80
|
| Rate for Payer: Networks By Design Commercial |
$1,362.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,781.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$2,096.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$503.04 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,257.60
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cigna of CA PPO |
$1,551.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,781.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,572.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$503.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,676.80
|
| Rate for Payer: Networks By Design Commercial |
$1,362.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,781.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,048.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,048.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,048.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,048.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$3,452.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$828.48 |
| Max. Negotiated Rate |
$2,934.20 |
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,380.80
|
| Rate for Payer: Galaxy Health WC |
$2,934.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,071.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,302.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.48
|
| Rate for Payer: Multiplan Commercial |
$2,761.60
|
| Rate for Payer: Networks By Design Commercial |
$2,243.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,934.20
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.76 |
| Max. Negotiated Rate |
$1,401.65 |
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.76
|
| Rate for Payer: Multiplan Commercial |
$1,319.20
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$3,452.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$828.48 |
| Max. Negotiated Rate |
$2,934.20 |
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,380.80
|
| Rate for Payer: Galaxy Health WC |
$2,934.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,071.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,302.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.48
|
| Rate for Payer: Multiplan Commercial |
$2,761.60
|
| Rate for Payer: Networks By Design Commercial |
$2,243.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,934.20
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$395.76 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$906.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$906.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$989.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cigna of CA PPO |
$1,220.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Dignity Health Media |
$1,401.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,401.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,236.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.76
|
| Rate for Payer: Multiplan Commercial |
$1,319.20
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$989.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.50
|
| Rate for Payer: United Healthcare All Other HMO |
$824.50
|
| Rate for Payer: United Healthcare HMO Rider |
$824.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,401.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,401.65
|
|
|
HC ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
OP
|
$7,139.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,283.40
|
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: Cigna of CA PPO |
$5,282.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$6,068.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,283.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,354.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,761.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$5,711.20
|
| Rate for Payer: Networks By Design Commercial |
$4,640.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,068.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,283.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,569.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,569.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,569.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,569.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
IP
|
$7,139.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,713.36 |
| Max. Negotiated Rate |
$6,068.15 |
| Rate for Payer: Cash Price |
$3,212.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,855.60
|
| Rate for Payer: Galaxy Health WC |
$6,068.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,283.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,761.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,719.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,713.36
|
| Rate for Payer: Multiplan Commercial |
$5,711.20
|
| Rate for Payer: Networks By Design Commercial |
$4,640.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,068.15
|
|
|
HC ADM FR D LOW A/D SAME DT-HR
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC ADM FR D LOW A/D SAME DT-HR
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$184.25
|
| Rate for Payer: Blue Shield of California EPN |
$146.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA PPO |
$185.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Media |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC ADM FR H-COMP A/D SAME/ HR
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$232.90 |
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
|
|
HC ADM FR H-COMP A/D SAME/ HR
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$164.40
|
| Rate for Payer: Blue Shield of California Commercial |
$201.94
|
| Rate for Payer: Blue Shield of California EPN |
$160.02
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.90
|
| Rate for Payer: Dignity Health Media |
$232.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.90
|
| Rate for Payer: Vantage Medical Group Senior |
$232.90
|
|
|
HC ADM FR HIGH A/D 2DATES/ HR
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$164.40
|
| Rate for Payer: Blue Shield of California Commercial |
$201.94
|
| Rate for Payer: Blue Shield of California EPN |
$160.02
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.90
|
| Rate for Payer: Dignity Health Media |
$232.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.90
|
| Rate for Payer: Vantage Medical Group Senior |
$232.90
|
|
|
HC ADM FR HIGH A/D 2DATES/ HR
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100006
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$65.76 |
| Max. Negotiated Rate |
$232.90 |
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
|
|
HC ADM FR MOD A/D SAME DT/HR
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC ADM FR MOD A/D SAME DT/HR
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100008
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$184.25
|
| Rate for Payer: Blue Shield of California EPN |
$146.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA PPO |
$185.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Media |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$187.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC ADMINISTRATION OF XOFIGO
|
Facility
|
IP
|
$3,258.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301549
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$781.92 |
| Max. Negotiated Rate |
$2,769.30 |
| Rate for Payer: Cash Price |
$1,466.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,303.20
|
| Rate for Payer: Galaxy Health WC |
$2,769.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,954.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,173.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,241.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.92
|
| Rate for Payer: Multiplan Commercial |
$2,606.40
|
| Rate for Payer: Networks By Design Commercial |
$2,117.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,769.30
|
|
|
HC ADMINISTRATION OF XOFIGO
|
Facility
|
OP
|
$3,258.00
|
|
|
Service Code
|
CPT 79101
|
| Hospital Charge Code |
909301549
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$239.67 |
| Max. Negotiated Rate |
$2,769.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$377.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,941.12
|
| Rate for Payer: Blue Distinction Transplant |
$1,954.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,925.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,528.00
|
| Rate for Payer: Cash Price |
$1,466.10
|
| Rate for Payer: Cash Price |
$1,466.10
|
| Rate for Payer: Cigna of CA HMO |
$2,085.12
|
| Rate for Payer: Cigna of CA PPO |
$2,410.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Media |
$310.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.84
|
| Rate for Payer: Galaxy Health WC |
$2,769.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,954.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,443.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Transplant |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,173.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$781.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.53
|
| Rate for Payer: Multiplan Commercial |
$2,606.40
|
| Rate for Payer: Networks By Design Commercial |
$2,117.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,769.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,954.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,954.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$589.62
|
| Rate for Payer: United Healthcare All Other HMO |
$589.62
|
| Rate for Payer: United Healthcare HMO Rider |
$589.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC ADMIN SOTROVIMAB INFUSION MA
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
949001325
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$726.75 |
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.00
|
| Rate for Payer: Galaxy Health WC |
$726.75
|
| Rate for Payer: Global Benefits Group Commercial |
$513.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.20
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
| Rate for Payer: Networks By Design Commercial |
$555.75
|
| Rate for Payer: Prime Health Services Commercial |
$726.75
|
|
|
HC ADMIN SOTROVIMAB INFUSION MA
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT M0247
|
| Hospital Charge Code |
949001325
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$205.20 |
| Max. Negotiated Rate |
$3,128.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,128.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$886.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$649.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$509.41
|
| Rate for Payer: Blue Distinction Transplant |
$513.00
|
| Rate for Payer: Blue Shield of California Commercial |
$630.14
|
| Rate for Payer: Blue Shield of California EPN |
$499.32
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Cigna of CA HMO |
$547.20
|
| Rate for Payer: Cigna of CA PPO |
$632.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$886.14
|
| Rate for Payer: Dignity Health Media |
$590.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$649.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$797.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$590.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$590.76
|
| Rate for Payer: Galaxy Health WC |
$726.75
|
| Rate for Payer: Global Benefits Group Commercial |
$513.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$641.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$968.85
|
| Rate for Payer: Heritage Provider Network Transplant |
$968.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$957.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$957.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$590.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$590.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$744.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$791.62
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
| Rate for Payer: Networks By Design Commercial |
$555.75
|
| Rate for Payer: Prime Health Services Commercial |
$726.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.50
|
| Rate for Payer: United Healthcare All Other HMO |
$427.50
|
| Rate for Payer: United Healthcare HMO Rider |
$427.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$886.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$649.84
|
| Rate for Payer: Vantage Medical Group Senior |
$590.76
|
|
|
HC ADMIN VACCINE EA ADDIT
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
908600205
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$53.55 |
| Rate for Payer: Cash Price |
$28.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.20
|
| Rate for Payer: Galaxy Health WC |
$53.55
|
| Rate for Payer: Global Benefits Group Commercial |
$37.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.12
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Networks By Design Commercial |
$40.95
|
| Rate for Payer: Prime Health Services Commercial |
$53.55
|
|
