|
HC CHROM ANLZ 5 CELLS 1 KARYO
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 88261
|
| Hospital Charge Code |
900918019
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$98.88 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.80
|
| Rate for Payer: Galaxy Health WC |
$350.20
|
| Rate for Payer: Global Benefits Group Commercial |
$247.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.88
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Networks By Design Commercial |
$267.80
|
| Rate for Payer: Prime Health Services Commercial |
$350.20
|
|
|
HC CHROM ANLZ ADDL KARYO
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900918018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$228.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$208.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.99
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.20
|
| Rate for Payer: Dignity Health Media |
$33.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$33.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$33.47
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$54.89
|
| Rate for Payer: Heritage Provider Network Transplant |
$54.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$54.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$54.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$33.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.85
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.11
|
| Rate for Payer: United Healthcare All Other HMO |
$27.11
|
| Rate for Payer: United Healthcare HMO Rider |
$27.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.82
|
| Rate for Payer: Vantage Medical Group Senior |
$33.47
|
|
|
HC CHROM ANLZ ADDL KARYO
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
900918018
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$13.92 |
| Max. Negotiated Rate |
$49.30 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.92
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
|
HC CILIARY TRANSSLERAL THERAPY
|
Facility
|
OP
|
$5,933.00
|
|
|
Service Code
|
CPT 66710
|
| Hospital Charge Code |
900566710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$472.53 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,559.80
|
| Rate for Payer: Cash Price |
$2,669.85
|
| Rate for Payer: Cash Price |
$2,669.85
|
| Rate for Payer: Cash Price |
$2,669.85
|
| Rate for Payer: Cigna of CA PPO |
$4,390.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$5,043.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,559.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,449.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| 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 |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,957.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$472.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,423.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$4,746.40
|
| Rate for Payer: Networks By Design Commercial |
$3,856.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,043.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,559.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,966.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,966.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,966.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,966.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC CILIARY TRANSSLERAL THERAPY
|
Facility
|
IP
|
$5,933.00
|
|
|
Service Code
|
CPT 66710
|
| Hospital Charge Code |
900566710
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,423.92 |
| Max. Negotiated Rate |
$5,043.05 |
| Rate for Payer: Cash Price |
$2,669.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,373.20
|
| Rate for Payer: Galaxy Health WC |
$5,043.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,559.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,957.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,260.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,423.92
|
| Rate for Payer: Multiplan Commercial |
$4,746.40
|
| Rate for Payer: Networks By Design Commercial |
$3,856.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,043.05
|
|
|
HC CIPROFLOXACIN E TEST
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912443
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.58
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC CIRC ANTICOAG SCRN
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$59.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.03
|
| Rate for Payer: Blue Distinction Transplant |
$15.00
|
| Rate for Payer: Blue Shield of California Commercial |
$16.15
|
| Rate for Payer: Blue Shield of California EPN |
$12.80
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.70
|
| Rate for Payer: Dignity Health Media |
$6.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.73
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.47
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.47
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$10.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CISTERNOGRAM
|
Facility
|
OP
|
$3,391.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
909301413
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$321.46 |
| Max. Negotiated Rate |
$2,882.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,925.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,020.36
|
| Rate for Payer: Blue Distinction Transplant |
$2,034.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,004.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,590.38
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: Cigna of CA HMO |
$2,170.24
|
| Rate for Payer: Cigna of CA PPO |
$2,509.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,543.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$321.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,712.80
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC CISTERNOGRAM
|
Facility
|
IP
|
$3,391.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
909301413
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$813.84 |
| Max. Negotiated Rate |
$2,882.35 |
| Rate for Payer: Cash Price |
$1,525.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.40
|
| Rate for Payer: Galaxy Health WC |
$2,882.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$813.84
|
| Rate for Payer: Multiplan Commercial |
$2,712.80
|
| Rate for Payer: Networks By Design Commercial |
$2,204.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,882.35
|
|
|
HC CITRULLINATED PEPTIDE AB
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$115.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.54
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.09
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.42
|
| Rate for Payer: Dignity Health Media |
$12.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.95
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.24
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC CK-MB
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
900910805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.68 |
| Max. Negotiated Rate |
$105.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$96.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.34
|
| Rate for Payer: Blue Distinction Transplant |
$19.20
|
| Rate for Payer: Blue Shield of California Commercial |
$20.67
|
| Rate for Payer: Blue Shield of California EPN |
$16.38
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$20.48
|
| Rate for Payer: Cigna of CA PPO |
$23.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.32
|
| Rate for Payer: Dignity Health Media |
$11.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.59
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.55
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$24.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.94
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.48
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO |
$9.36
|
| Rate for Payer: United Healthcare HMO Rider |
$9.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.70
|
| Rate for Payer: Vantage Medical Group Senior |
$11.55
|
|
|
HC CLAVICLE
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$660.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$130.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.24
|
| Rate for Payer: Blue Distinction Transplant |
$466.20
|
| Rate for Payer: Blue Shield of California Commercial |
$459.21
|
| Rate for Payer: Blue Shield of California EPN |
$364.41
|
| Rate for Payer: Cash Price |
$349.65
|
| Rate for Payer: Cash Price |
$349.65
|
| Rate for Payer: Cigna of CA HMO |
$497.28
|
| Rate for Payer: Cigna of CA PPO |
$574.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$660.45
|
| Rate for Payer: Global Benefits Group Commercial |
$466.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$582.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: Networks By Design Commercial |
$505.05
|
| Rate for Payer: Prime Health Services Commercial |
$660.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC CLAVICLE
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.48 |
| Max. Negotiated Rate |
$660.45 |
| Rate for Payer: Cash Price |
$349.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.80
|
| Rate for Payer: Galaxy Health WC |
$660.45
|
| Rate for Payer: Global Benefits Group Commercial |
$466.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.48
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: Networks By Design Commercial |
$505.05
|
| Rate for Payer: Prime Health Services Commercial |
$660.45
|
|
|
HC CLINICAL TRIAL PROTOCOL-OBS/HR
|
Facility
|
OP
|
$208.00
|
|
| Hospital Charge Code |
907299236
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$49.92 |
| Max. Negotiated Rate |
$2,485.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,485.00
|
| Rate for Payer: Blue Distinction Transplant |
$124.80
|
| Rate for Payer: Blue Shield of California Commercial |
$153.30
|
| Rate for Payer: Blue Shield of California EPN |
$121.47
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna of CA HMO |
$133.12
|
| Rate for Payer: Cigna of CA PPO |
$153.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.80
|
| Rate for Payer: Dignity Health Media |
$176.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.00
|
| Rate for Payer: United Healthcare All Other HMO |
$104.00
|
| Rate for Payer: United Healthcare HMO Rider |
$104.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.80
|
| Rate for Payer: Vantage Medical Group Senior |
$176.80
|
|
|
HC CLINICAL TRIAL PROTOCOL-OBS/HR
|
Facility
|
IP
|
$208.00
|
|
| Hospital Charge Code |
907299236
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$49.92 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
OP
|
$4,047.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$497.29 |
| 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 |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,428.20
|
| Rate for Payer: Cash Price |
$1,821.15
|
| Rate for Payer: Cash Price |
$1,821.15
|
| Rate for Payer: Cash Price |
$1,821.15
|
| Rate for Payer: Cigna of CA PPO |
$2,994.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$3,439.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,035.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| 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 |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,699.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$3,237.60
|
| Rate for Payer: Networks By Design Commercial |
$2,630.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,439.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,428.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,023.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,023.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,023.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,023.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
IP
|
$4,047.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$971.28 |
| Max. Negotiated Rate |
$3,439.95 |
| Rate for Payer: Cash Price |
$1,821.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,618.80
|
| Rate for Payer: Galaxy Health WC |
$3,439.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,699.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,541.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$971.28
|
| Rate for Payer: Multiplan Commercial |
$3,237.60
|
| Rate for Payer: Networks By Design Commercial |
$2,630.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,439.95
|
|
|
HC CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$834.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.16 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$500.40
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Cigna of CA PPO |
$617.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$625.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| 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 |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$667.20
|
| Rate for Payer: Networks By Design Commercial |
$542.10
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$500.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$417.00
|
| Rate for Payer: United Healthcare HMO Rider |
$417.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$417.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.16 |
| Max. Negotiated Rate |
$708.90 |
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.60
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.16
|
| Rate for Payer: Multiplan Commercial |
$667.20
|
| Rate for Payer: Networks By Design Commercial |
$542.10
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
IP
|
$4,373.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,049.52 |
| Max. Negotiated Rate |
$3,717.05 |
| Rate for Payer: Cash Price |
$1,967.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,749.20
|
| Rate for Payer: Galaxy Health WC |
$3,717.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,623.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,916.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,666.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.52
|
| Rate for Payer: Multiplan Commercial |
$3,498.40
|
| Rate for Payer: Networks By Design Commercial |
$2,842.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,717.05
|
|
|
HC CLOSED TX VERTEBRAL FX W/MAN
|
Facility
|
OP
|
$4,373.00
|
|
|
Service Code
|
CPT 22315
|
| Hospital Charge Code |
900501789
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$756.18 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,623.80
|
| Rate for Payer: Cash Price |
$1,967.85
|
| Rate for Payer: Cash Price |
$1,967.85
|
| Rate for Payer: Cash Price |
$1,967.85
|
| Rate for Payer: Cigna of CA PPO |
$3,236.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$3,717.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,623.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,279.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| 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 |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,916.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$756.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$3,498.40
|
| Rate for Payer: Networks By Design Commercial |
$2,842.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,717.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,623.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,186.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,186.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,186.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,186.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
OP
|
$979.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.96 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$587.40
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: Cigna of CA PPO |
$724.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$832.15
|
| Rate for Payer: Global Benefits Group Commercial |
$587.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$734.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| 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 |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$783.20
|
| Rate for Payer: Networks By Design Commercial |
$636.35
|
| Rate for Payer: Prime Health Services Commercial |
$832.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$587.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$489.50
|
| Rate for Payer: United Healthcare All Other HMO |
$489.50
|
| Rate for Payer: United Healthcare HMO Rider |
$489.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$489.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CLOSE TREAT CALCANEAL FX W/O M
|
Facility
|
IP
|
$979.00
|
|
|
Service Code
|
CPT 28400
|
| Hospital Charge Code |
900501669
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$234.96 |
| Max. Negotiated Rate |
$832.15 |
| Rate for Payer: Cash Price |
$440.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.60
|
| Rate for Payer: Galaxy Health WC |
$832.15
|
| Rate for Payer: Global Benefits Group Commercial |
$587.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.96
|
| Rate for Payer: Multiplan Commercial |
$783.20
|
| Rate for Payer: Networks By Design Commercial |
$636.35
|
| Rate for Payer: Prime Health Services Commercial |
$832.15
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.94 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$982.80
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: Cigna of CA PPO |
$1,212.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,228.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| 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 |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$224.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$982.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$819.00
|
| Rate for Payer: United Healthcare All Other HMO |
$819.00
|
| Rate for Payer: United Healthcare HMO Rider |
$819.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$819.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC CLOSE TREAT TALOTARSAL JOINT
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 28570
|
| Hospital Charge Code |
900501749
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$393.12 |
| Max. Negotiated Rate |
$1,392.30 |
| Rate for Payer: Cash Price |
$737.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$655.20
|
| Rate for Payer: Galaxy Health WC |
$1,392.30
|
| Rate for Payer: Global Benefits Group Commercial |
$982.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,092.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$624.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$393.12
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Networks By Design Commercial |
$1,064.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,392.30
|
|
