|
HC BIOFEEDBACK PERI/URO/RECTAL
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 90911
|
| Hospital Charge Code |
906790911
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.86
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.60
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.80
|
| Rate for Payer: Vantage Medical Group Senior |
$244.80
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.84
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
|
|
HC BIOFEEDBACK TRNG 1ST 15 MIN
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 90912
|
| Hospital Charge Code |
906790912
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.65
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna of CA HMO |
$138.24
|
| Rate for Payer: Cigna of CA PPO |
$159.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.60
|
| Rate for Payer: Vantage Medical Group Senior |
$183.60
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$1,570.00 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.43
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.90
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,129.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$73.95
|
|
|
HC BIOFEEDBACK TRNG EA ADD 15 MIN
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 90913
|
| Hospital Charge Code |
906790913
|
|
Hospital Revenue Code
|
917
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$73.95 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$39.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.88
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
CPT 76818 59
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$246.56 |
| Max. Negotiated Rate |
$1,307.30 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,008.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,307.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$845.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,153.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$944.49
|
| Rate for Payer: Blue Shield of California Commercial |
$941.26
|
| Rate for Payer: Blue Shield of California EPN |
$621.35
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cigna of CA HMO |
$984.32
|
| Rate for Payer: Cigna of CA PPO |
$1,138.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,307.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,307.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,307.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$615.20
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,025.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$952.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,076.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,076.60
|
| Rate for Payer: Multiplan Commercial |
$1,230.40
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$922.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$922.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,307.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,307.30
|
| Rate for Payer: Vantage Medical Group Senior |
$1,307.30
|
|
|
HC BIOPHYSICAL PROFILE W NST ADDL FETUS
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
CPT 76818 59
|
| Hospital Charge Code |
910400112
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$1,307.30 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$615.20
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,025.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$952.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.12
|
| Rate for Payer: Multiplan Commercial |
$1,230.40
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
|
OP
|
$1,538.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,307.30 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,008.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$944.49
|
| Rate for Payer: Blue Shield of California Commercial |
$941.26
|
| Rate for Payer: Blue Shield of California EPN |
$621.35
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: Cigna of CA HMO |
$984.32
|
| Rate for Payer: Cigna of CA PPO |
$1,138.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,025.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,230.40
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$922.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$922.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC BIOPHYSICAL PROFILE W NST SINGLE FETUS
|
Facility
|
IP
|
$1,538.00
|
|
|
Service Code
|
CPT 76818
|
| Hospital Charge Code |
910400111
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$307.60 |
| Max. Negotiated Rate |
$1,307.30 |
| Rate for Payer: Adventist Health Commercial |
$307.60
|
| Rate for Payer: Cash Price |
$692.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$615.20
|
| Rate for Payer: Galaxy Health WC |
$1,307.30
|
| Rate for Payer: Global Benefits Group Commercial |
$922.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,025.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$952.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.12
|
| Rate for Payer: Multiplan Commercial |
$1,230.40
|
| Rate for Payer: Networks By Design Commercial |
$999.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,307.30
|
|
|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
CPT 76819 59
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$438.60 |
| Max. Negotiated Rate |
$1,864.05 |
| Rate for Payer: Adventist Health Commercial |
$438.60
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.20
|
| Rate for Payer: EPIC Health Plan Senior |
$877.20
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,357.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Multiplan Commercial |
$1,754.40
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
|
|
HC BIOPHYSICAL PROFILE WO NST ADDL FETUS
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
CPT 76819 59
|
| Hospital Charge Code |
910400114
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$129.19 |
| Max. Negotiated Rate |
$1,864.05 |
| Rate for Payer: Adventist Health Commercial |
$438.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,438.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,864.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,644.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,346.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,342.12
|
| Rate for Payer: Blue Shield of California EPN |
$885.97
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Cigna of CA HMO |
$1,403.52
|
| Rate for Payer: Cigna of CA PPO |
$1,622.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,864.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,864.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,864.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.20
|
| Rate for Payer: EPIC Health Plan Senior |
$877.20
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,357.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,535.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,535.10
|
| Rate for Payer: Multiplan Commercial |
$1,754.40
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,864.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,864.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,864.05
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
|
OP
|
$2,193.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$1,864.05 |
| Rate for Payer: Adventist Health Commercial |
$438.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,438.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,346.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,342.12
|
| Rate for Payer: Blue Shield of California EPN |
$885.97
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: Cigna of CA HMO |
$1,403.52
|
| Rate for Payer: Cigna of CA PPO |
$1,622.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$132.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,754.40
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,315.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,315.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC BIOPHYSICAL PROFILE WO NST SINGLE FETUS
|
Facility
|
IP
|
$2,193.00
|
|
|
Service Code
|
CPT 76819
|
| Hospital Charge Code |
910400113
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$438.60 |
| Max. Negotiated Rate |
$1,864.05 |
| Rate for Payer: Adventist Health Commercial |
$438.60
|
| Rate for Payer: Cash Price |
$986.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.20
|
| Rate for Payer: EPIC Health Plan Senior |
$877.20
|
| Rate for Payer: Galaxy Health WC |
$1,864.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,462.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,357.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.32
|
| Rate for Payer: Multiplan Commercial |
$1,754.40
|
| Rate for Payer: Networks By Design Commercial |
$1,425.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,864.05
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
|
IP
|
$10,214.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,042.80 |
| Max. Negotiated Rate |
$8,681.90 |
| Rate for Payer: Adventist Health Commercial |
$2,042.80
|
| Rate for Payer: Cash Price |
$4,596.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,085.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,085.60
|
| Rate for Payer: Galaxy Health WC |
$8,681.90
|
| Rate for Payer: Global Benefits Group Commercial |
$6,128.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,812.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,891.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,322.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,451.36
|
| Rate for Payer: Multiplan Commercial |
$8,171.20
|
| Rate for Payer: Networks By Design Commercial |
$6,639.10
|
| Rate for Payer: Prime Health Services Commercial |
$8,681.90
|
|
|
HC BIOPSY ANORECTAL WALL
|
Facility
|
OP
|
$7,631.00
|
|
|
Service Code
|
CPT 45100
|
| Hospital Charge Code |
906745100
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$283.33 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,526.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Cash Price |
$3,433.95
|
| Rate for Payer: Cigna of CA HMO |
$4,883.84
|
| Rate for Payer: Cigna of CA PPO |
$5,646.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,704.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.48
|
| Rate for Payer: Galaxy Health WC |
$6,486.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,578.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,714.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$283.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,089.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,831.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,669.20
|
| Rate for Payer: Multiplan Commercial |
$6,104.80
|
| Rate for Payer: Networks By Design Commercial |
$4,960.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,486.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,578.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,181.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,484.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$76.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cigna of CA HMO |
$789.76
|
| Rate for Payer: Cigna of CA PPO |
$913.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$617.00
|
| Rate for Payer: United Healthcare All Other HMO |
$617.00
|
| Rate for Payer: United Healthcare HMO Rider |
$617.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$617.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC BIOPSY EXTERNAL EAR
|
Facility
|
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 69100
|
| Hospital Charge Code |
900501504
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,048.90 |
| Rate for Payer: Adventist Health Commercial |
$246.80
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Senior |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$470.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$763.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.16
|
| Rate for Payer: Multiplan Commercial |
$987.20
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
|
|
HC BIOPSY OF CERVIX
|
Facility
|
IP
|
$1,926.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$1,637.10 |
| Rate for Payer: Adventist Health Commercial |
$385.20
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.40
|
| Rate for Payer: EPIC Health Plan Senior |
$770.40
|
| Rate for Payer: Galaxy Health WC |
$1,637.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,284.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,192.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.24
|
| Rate for Payer: Multiplan Commercial |
$1,540.80
|
| Rate for Payer: Networks By Design Commercial |
$1,251.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.10
|
|
|
HC BIOPSY OF CERVIX
|
Facility
|
OP
|
$1,926.00
|
|
|
Service Code
|
CPT 57500
|
| Hospital Charge Code |
900501433
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$77.03 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$385.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,106.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cigna of CA HMO |
$1,232.64
|
| Rate for Payer: Cigna of CA PPO |
$1,425.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,217.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,106.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.59
|
| Rate for Payer: EPIC Health Plan Senior |
$1,106.36
|
| Rate for Payer: Galaxy Health WC |
$1,637.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,814.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,106.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,284.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,106.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,394.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,482.52
|
| Rate for Payer: Multiplan Commercial |
$1,540.80
|
| Rate for Payer: Multiplan WC |
$1,762.79
|
| Rate for Payer: Networks By Design Commercial |
$1,251.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.10
|
| Rate for Payer: Prime Health Services WC |
$1,744.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,155.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$963.00
|
| Rate for Payer: United Healthcare All Other HMO |
$963.00
|
| Rate for Payer: United Healthcare HMO Rider |
$963.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$963.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,106.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,659.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,217.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,106.36
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
|
OP
|
$5,254.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$175.12 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,050.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$2,364.30
|
| Rate for Payer: Cash Price |
$2,364.30
|
| Rate for Payer: Cash Price |
$2,364.30
|
| Rate for Payer: Cigna of CA HMO |
$3,362.56
|
| Rate for Payer: Cigna of CA PPO |
$3,887.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$4,465.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,152.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,504.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$4,203.20
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$3,415.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,465.90
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,152.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC BIOPSY OF HIP JOINT
|
Facility
|
IP
|
$5,254.00
|
|
|
Service Code
|
CPT 27052
|
| Hospital Charge Code |
909020043
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,050.80 |
| Max. Negotiated Rate |
$4,465.90 |
| Rate for Payer: Adventist Health Commercial |
$1,050.80
|
| Rate for Payer: Cash Price |
$2,364.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,101.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,101.60
|
| Rate for Payer: Galaxy Health WC |
$4,465.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,152.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,504.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,001.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,252.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.96
|
| Rate for Payer: Multiplan Commercial |
$4,203.20
|
| Rate for Payer: Networks By Design Commercial |
$3,415.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,465.90
|
|
|
HC BIOPSY OF TONGUE
|
Facility
|
OP
|
$2,139.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.74 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: Cigna of CA HMO |
$1,368.96
|
| Rate for Payer: Cigna of CA PPO |
$1,582.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,426.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,283.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,069.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,069.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,069.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,069.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC BIOPSY OF TONGUE
|
Facility
|
IP
|
$2,139.00
|
|
|
Service Code
|
CPT 41100
|
| Hospital Charge Code |
900541100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.80 |
| Max. Negotiated Rate |
$1,818.15 |
| Rate for Payer: Adventist Health Commercial |
$427.80
|
| Rate for Payer: Cash Price |
$962.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$855.60
|
| Rate for Payer: EPIC Health Plan Senior |
$855.60
|
| Rate for Payer: Galaxy Health WC |
$1,818.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,283.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,426.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$814.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,324.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.36
|
| Rate for Payer: Multiplan Commercial |
$1,711.20
|
| Rate for Payer: Networks By Design Commercial |
$1,390.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,818.15
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
IP
|
$2,863.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$572.60 |
| Max. Negotiated Rate |
$2,433.55 |
| Rate for Payer: Adventist Health Commercial |
$572.60
|
| Rate for Payer: Cash Price |
$1,288.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,145.20
|
| Rate for Payer: Galaxy Health WC |
$2,433.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,909.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,090.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,772.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.12
|
| Rate for Payer: Multiplan Commercial |
$2,290.40
|
| Rate for Payer: Networks By Design Commercial |
$1,860.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,433.55
|
|
|
HC BIOPSY SINONASAL MASS PALAT
|
Facility
|
OP
|
$2,863.00
|
|
|
Service Code
|
CPT 42100
|
| Hospital Charge Code |
900501728
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$572.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,288.35
|
| Rate for Payer: Cash Price |
$1,288.35
|
| Rate for Payer: Cash Price |
$1,288.35
|
| Rate for Payer: Cigna of CA HMO |
$1,832.32
|
| Rate for Payer: Cigna of CA PPO |
$2,118.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$2,433.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,717.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,909.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$2,290.40
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$1,860.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,433.55
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,717.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,431.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,431.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,431.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,431.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
