|
HC DESIGN MIC DEVICE FOR IMRT
|
Facility
|
OP
|
$1,576.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
909100215
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$378.24 |
| Max. Negotiated Rate |
$2,327.11 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,662.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,327.11
|
| Rate for Payer: Blue Distinction Transplant |
$945.60
|
| Rate for Payer: Blue Shield of California Commercial |
$931.42
|
| Rate for Payer: Blue Shield of California EPN |
$739.14
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cash Price |
$709.20
|
| Rate for Payer: Cigna of CA HMO |
$1,008.64
|
| Rate for Payer: Cigna of CA PPO |
$1,166.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$1,339.60
|
| Rate for Payer: Global Benefits Group Commercial |
$945.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,182.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$757.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$747.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,051.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$378.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$581.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$1,260.80
|
| Rate for Payer: Networks By Design Commercial |
$1,024.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,339.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$945.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.40 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$186.00
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna of CA PPO |
$229.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$232.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| 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 |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$155.00
|
| Rate for Payer: United Healthcare HMO Rider |
$155.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.20 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$273.00
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$341.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| 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 |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.50
|
| Rate for Payer: United Healthcare All Other HMO |
$227.50
|
| Rate for Payer: United Healthcare HMO Rider |
$227.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$386.75 |
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.96 |
| Max. Negotiated Rate |
$619.65 |
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.60
|
| Rate for Payer: Galaxy Health WC |
$619.65
|
| Rate for Payer: Global Benefits Group Commercial |
$437.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$277.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.96
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: Networks By Design Commercial |
$473.85
|
| Rate for Payer: Prime Health Services Commercial |
$619.65
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$83.47 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$437.40
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Cigna of CA PPO |
$539.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$619.65
|
| Rate for Payer: Global Benefits Group Commercial |
$437.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$546.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| 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 |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$583.20
|
| Rate for Payer: Networks By Design Commercial |
$473.85
|
| Rate for Payer: Prime Health Services Commercial |
$619.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.50
|
| Rate for Payer: United Healthcare All Other HMO |
$364.50
|
| Rate for Payer: United Healthcare HMO Rider |
$364.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.72 |
| Max. Negotiated Rate |
$852.55 |
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$240.72 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$601.80
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cigna of CA PPO |
$742.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$752.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| 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 |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$501.50
|
| Rate for Payer: United Healthcare All Other HMO |
$501.50
|
| Rate for Payer: United Healthcare HMO Rider |
$501.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DESTROY INTERNAL HEMORRHOIDS
|
Facility
|
OP
|
$2,997.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
906746930
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$200.18 |
| 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 |
$2,211.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,798.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,348.65
|
| Rate for Payer: Cash Price |
$1,348.65
|
| Rate for Payer: Cigna of CA PPO |
$2,217.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Dignity Health Media |
$1,474.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$2,547.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,247.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,418.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,418.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,388.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,388.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,474.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,999.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,857.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$2,397.60
|
| Rate for Payer: Networks By Design Commercial |
$1,948.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,547.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,798.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC DESTROY INTERNAL HEMORRHOIDS
|
Facility
|
IP
|
$2,997.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
906746930
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$719.28 |
| Max. Negotiated Rate |
$2,547.45 |
| Rate for Payer: Cash Price |
$1,348.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,198.80
|
| Rate for Payer: Galaxy Health WC |
$2,547.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,798.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,999.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,141.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$719.28
|
| Rate for Payer: Multiplan Commercial |
$2,397.60
|
| Rate for Payer: Networks By Design Commercial |
$1,948.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,547.45
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$178.80
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Media |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$223.50
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$149.00
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$71.52 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$673.25
|
| Rate for Payer: Blue Distinction Transplant |
$678.00
|
| Rate for Payer: Blue Shield of California Commercial |
$832.81
|
| Rate for Payer: Blue Shield of California EPN |
$659.92
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Media |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$847.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$565.00
|
| Rate for Payer: United Healthcare All Other HMO |
$565.00
|
| Rate for Payer: United Healthcare HMO Rider |
$565.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$565.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$678.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Media |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$847.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$678.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Media |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$847.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$271.20 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$12.10 |
| Max. Negotiated Rate |
$960.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$621.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$678.00
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cash Price |
$508.50
|
| Rate for Payer: Cigna of CA HMO |
$723.20
|
| Rate for Payer: Cigna of CA PPO |
$836.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$960.50
|
| Rate for Payer: Dignity Health Media |
$960.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$960.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$452.00
|
| Rate for Payer: Galaxy Health WC |
$960.50
|
| Rate for Payer: Global Benefits Group Commercial |
$678.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$847.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$753.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.20
|
| Rate for Payer: Multiplan Commercial |
$904.00
|
| Rate for Payer: Networks By Design Commercial |
$734.50
|
| Rate for Payer: Prime Health Services Commercial |
$960.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$960.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$960.50
|
| Rate for Payer: Vantage Medical Group Senior |
$960.50
|
|
|
HC DHEA-S
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 82627
|
| Hospital Charge Code |
900912126
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$202.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$184.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.82
|
| Rate for Payer: Blue Distinction Transplant |
$40.20
|
| Rate for Payer: Blue Shield of California Commercial |
$43.28
|
| Rate for Payer: Blue Shield of California EPN |
$34.30
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cash Price |
$30.15
|
| Rate for Payer: Cigna of CA HMO |
$42.88
|
| Rate for Payer: Cigna of CA PPO |
$49.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.34
|
| Rate for Payer: Dignity Health Media |
$22.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.23
|
| Rate for Payer: Galaxy Health WC |
$56.95
|
| Rate for Payer: Global Benefits Group Commercial |
$40.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$50.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.46
|
| Rate for Payer: Heritage Provider Network Transplant |
$36.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$36.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Networks By Design Commercial |
$43.55
|
| Rate for Payer: Prime Health Services Commercial |
$56.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.01
|
| Rate for Payer: United Healthcare All Other HMO |
$18.01
|
| Rate for Payer: United Healthcare HMO Rider |
$18.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.45
|
| Rate for Payer: Vantage Medical Group Senior |
$22.23
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$32.64 |
| Max. Negotiated Rate |
$115.60 |
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
|
|
HC DIAB OP SELF MGMT-GRP 30 MIN
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT G0109
|
| Hospital Charge Code |
902501101
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.87 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.03
|
| Rate for Payer: Blue Distinction Transplant |
$81.60
|
| Rate for Payer: Blue Shield of California Commercial |
$100.23
|
| Rate for Payer: Blue Shield of California EPN |
$79.42
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115.60
|
| Rate for Payer: Dignity Health Media |
$115.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$115.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$54.40
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115.60
|
| Rate for Payer: Vantage Medical Group Senior |
$115.60
|
|
|
HC DIAB OP SELF MGMT-INDIV 30 MIN
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT G0108
|
| Hospital Charge Code |
902501100
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$74.64 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$320.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$185.29
|
| Rate for Payer: Blue Distinction Transplant |
$186.60
|
| Rate for Payer: Blue Shield of California Commercial |
$229.21
|
| Rate for Payer: Blue Shield of California EPN |
$181.62
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cash Price |
$139.95
|
| Rate for Payer: Cigna of CA HMO |
$199.04
|
| Rate for Payer: Cigna of CA PPO |
$230.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$264.35
|
| Rate for Payer: Dignity Health Media |
$264.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$264.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$124.40
|
| Rate for Payer: Galaxy Health WC |
$264.35
|
| Rate for Payer: Global Benefits Group Commercial |
$186.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$233.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$207.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.64
|
| Rate for Payer: Multiplan Commercial |
$248.80
|
| Rate for Payer: Networks By Design Commercial |
$202.15
|
| Rate for Payer: Prime Health Services Commercial |
$264.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$264.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$264.35
|
| Rate for Payer: Vantage Medical Group Senior |
$264.35
|
|
