|
HC EGD W/INSRT GIDE WIRE
|
Facility
|
OP
|
$3,274.00
|
|
|
Service Code
|
CPT 43248
|
| Hospital Charge Code |
906743248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$280.82 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,964.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cigna of CA PPO |
$2,422.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$2,782.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,964.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,455.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,183.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,619.20
|
| Rate for Payer: Networks By Design Commercial |
$2,128.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,782.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,964.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
IP
|
$5,475.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,314.00 |
| Max. Negotiated Rate |
$4,653.75 |
| Rate for Payer: Cash Price |
$2,463.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,190.00
|
| Rate for Payer: Galaxy Health WC |
$4,653.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,285.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,651.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,085.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.00
|
| Rate for Payer: Multiplan Commercial |
$4,380.00
|
| Rate for Payer: Networks By Design Commercial |
$3,558.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,653.75
|
|
|
HC EGD W/REMOVAL FOREIGN BODY
|
Facility
|
OP
|
$3,658.00
|
|
|
Service Code
|
CPT 43247
|
| Hospital Charge Code |
906743247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$485.26 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,194.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cigna of CA PPO |
$2,706.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,109.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,194.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,743.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,439.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$877.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$2,926.40
|
| Rate for Payer: Networks By Design Commercial |
$2,377.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,109.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,194.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
OP
|
$2,351.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$564.24 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,410.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,057.95
|
| Rate for Payer: Cash Price |
$1,057.95
|
| Rate for Payer: Cigna of CA PPO |
$1,739.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$1,998.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,410.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,763.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,568.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,880.80
|
| Rate for Payer: Networks By Design Commercial |
$1,528.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,998.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,410.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W/REMOV TUMOR/POLYP/LESION
|
Facility
|
IP
|
$4,398.00
|
|
|
Service Code
|
CPT 43251
|
| Hospital Charge Code |
906743251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,055.52 |
| Max. Negotiated Rate |
$3,738.30 |
| Rate for Payer: Cash Price |
$1,979.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,759.20
|
| Rate for Payer: Galaxy Health WC |
$3,738.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,638.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,933.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,675.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,055.52
|
| Rate for Payer: Multiplan Commercial |
$3,518.40
|
| Rate for Payer: Networks By Design Commercial |
$2,858.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,738.30
|
|
|
HC EGD W/TRANSENDO TUBE/CATH PLAC
|
Facility
|
OP
|
$3,553.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$852.72 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,131.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cash Price |
$1,598.85
|
| Rate for Payer: Cigna of CA PPO |
$2,629.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,020.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,131.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,664.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,369.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$852.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$2,842.40
|
| Rate for Payer: Networks By Design Commercial |
$2,309.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,020.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,131.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W/TRANSENDO TUBE/CATH PLAC
|
Facility
|
IP
|
$6,305.00
|
|
|
Service Code
|
CPT 43241
|
| Hospital Charge Code |
906743241
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,513.20 |
| Max. Negotiated Rate |
$5,359.25 |
| Rate for Payer: Cash Price |
$2,837.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,522.00
|
| Rate for Payer: Galaxy Health WC |
$5,359.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,783.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,205.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,402.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,513.20
|
| Rate for Payer: Multiplan Commercial |
$5,044.00
|
| Rate for Payer: Networks By Design Commercial |
$4,098.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,359.25
|
|
|
HC EGD W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
IP
|
$7,094.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,702.56 |
| Max. Negotiated Rate |
$6,029.90 |
| Rate for Payer: Cash Price |
$3,192.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,837.60
|
| Rate for Payer: Galaxy Health WC |
$6,029.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,256.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,731.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,702.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,702.56
|
| Rate for Payer: Multiplan Commercial |
$5,675.20
|
| Rate for Payer: Networks By Design Commercial |
$4,611.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,029.90
|
|
|
HC EGD W/TRNSMRL DRNG/ PSEUDOCYST
|
Facility
|
OP
|
$3,834.00
|
|
|
Service Code
|
CPT 43240
|
| Hospital Charge Code |
906743240
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$664.92 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,300.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,725.30
|
| Rate for Payer: Cash Price |
$1,725.30
|
| Rate for Payer: Cigna of CA PPO |
$2,837.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Media |
$7,120.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,613.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,120.83
|
| Rate for Payer: Galaxy Health WC |
$3,258.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,300.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,875.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,678.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,678.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,535.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,535.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,557.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$664.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$920.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.91
|
| Rate for Payer: Multiplan Commercial |
$3,067.20
|
| Rate for Payer: Networks By Design Commercial |
$2,492.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,258.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,300.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
OP
|
$4,416.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$476.77 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,649.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cash Price |
$1,987.20
|
| Rate for Payer: Cigna of CA PPO |
$3,267.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$3,753.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,649.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,312.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,945.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$476.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,059.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$3,532.80
|
| Rate for Payer: Networks By Design Commercial |
$2,870.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,753.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,649.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC EGD W/US GUID INTRMRL
|
Facility
|
IP
|
$6,608.00
|
|
|
Service Code
|
CPT 43242
|
| Hospital Charge Code |
906743242
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,585.92 |
| Max. Negotiated Rate |
$5,616.80 |
| Rate for Payer: Cash Price |
$2,973.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Galaxy Health WC |
$5,616.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,517.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,585.92
|
| Rate for Payer: Multiplan Commercial |
$5,286.40
|
| Rate for Payer: Networks By Design Commercial |
$4,295.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,616.80
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.00
|
| Rate for Payer: Dignity Health Media |
$357.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.80 |
| 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 |
$357.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$231.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$231.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$252.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$357.00
|
| Rate for Payer: Dignity Health Media |
$357.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$357.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$315.00
|
| 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 |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$388.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$357.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$357.00
|
| Rate for Payer: Vantage Medical Group Senior |
$357.00
|
|
|
HC ELBOW ARTHROGRAPHY INJECT
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 24220
|
| Hospital Charge Code |
909000114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$357.00 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC ELBOW COMPLETE
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
909001512
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$870.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$163.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.89
|
| Rate for Payer: Blue Distinction Transplant |
$614.40
|
| Rate for Payer: Blue Shield of California Commercial |
$605.18
|
| Rate for Payer: Blue Shield of California EPN |
$480.26
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna of CA HMO |
$655.36
|
| Rate for Payer: Cigna of CA PPO |
$757.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$870.40
|
| Rate for Payer: Global Benefits Group Commercial |
$614.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$768.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$683.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: Networks By Design Commercial |
$665.60
|
| Rate for Payer: Prime Health Services Commercial |
$870.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$614.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$614.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ELBOW COMPLETE
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 73080
|
| Hospital Charge Code |
909001512
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.76 |
| Max. Negotiated Rate |
$870.40 |
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.60
|
| Rate for Payer: Galaxy Health WC |
$870.40
|
| Rate for Payer: Global Benefits Group Commercial |
$614.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$683.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.76
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: Networks By Design Commercial |
$665.60
|
| Rate for Payer: Prime Health Services Commercial |
$870.40
|
|
|
HC ELBOW LIMITED 2 VIEW
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
909001511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.76 |
| Max. Negotiated Rate |
$615.40 |
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$289.60
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$275.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.76
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Networks By Design Commercial |
$470.60
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
|
|
HC ELBOW LIMITED 2 VIEW
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
909001511
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$615.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$130.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.24
|
| Rate for Payer: Blue Distinction Transplant |
$434.40
|
| Rate for Payer: Blue Shield of California Commercial |
$427.88
|
| Rate for Payer: Blue Shield of California EPN |
$339.56
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cash Price |
$325.80
|
| Rate for Payer: Cigna of CA HMO |
$463.36
|
| Rate for Payer: Cigna of CA PPO |
$535.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$615.40
|
| Rate for Payer: Global Benefits Group Commercial |
$434.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$543.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$482.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Networks By Design Commercial |
$470.60
|
| Rate for Payer: Prime Health Services Commercial |
$615.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$434.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$434.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ELECTROCORTICOGRAPHY,INTRAOP
|
Facility
|
IP
|
$2,050.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
900600800
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$492.00 |
| Max. Negotiated Rate |
$1,742.50 |
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$820.00
|
| Rate for Payer: Galaxy Health WC |
$1,742.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,230.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,367.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$781.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.00
|
| Rate for Payer: Multiplan Commercial |
$1,640.00
|
| Rate for Payer: Networks By Design Commercial |
$1,332.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,742.50
|
|
|
HC ELECTROCORTICOGRAPHY,INTRAOP
|
Facility
|
OP
|
$2,050.00
|
|
|
Service Code
|
CPT 95829
|
| Hospital Charge Code |
900600800
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$422.71 |
| Max. Negotiated Rate |
$8,160.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,160.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,742.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,127.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,127.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,221.39
|
| Rate for Payer: Blue Distinction Transplant |
$1,230.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,211.55
|
| Rate for Payer: Blue Shield of California EPN |
$961.45
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cash Price |
$922.50
|
| Rate for Payer: Cigna of CA HMO |
$1,312.00
|
| Rate for Payer: Cigna of CA PPO |
$1,517.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,742.50
|
| Rate for Payer: Dignity Health Media |
$1,742.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,742.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$820.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$820.00
|
| Rate for Payer: Galaxy Health WC |
$1,742.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,230.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,537.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,367.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.00
|
| Rate for Payer: Multiplan Commercial |
$1,640.00
|
| Rate for Payer: Networks By Design Commercial |
$1,332.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,742.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,230.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,230.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,742.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,742.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,742.50
|
|
|
HC ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
|
OP
|
$1,567.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$178.68 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$778.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$933.62
|
| Rate for Payer: Blue Distinction Transplant |
$940.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$705.15
|
| Rate for Payer: Cash Price |
$705.15
|
| Rate for Payer: Cash Price |
$705.15
|
| Rate for Payer: Cigna of CA PPO |
$1,159.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$1,331.95
|
| Rate for Payer: Global Benefits Group Commercial |
$940.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,175.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,045.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$1,253.60
|
| Rate for Payer: Networks By Design Commercial |
$1,018.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$940.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC ELECTROGSTROGRPHY DIAG TRANSCU
|
Facility
|
IP
|
$2,837.00
|
|
|
Service Code
|
CPT 91132
|
| Hospital Charge Code |
906791132
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$680.88 |
| Max. Negotiated Rate |
$2,411.45 |
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,134.80
|
| Rate for Payer: Galaxy Health WC |
$2,411.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,080.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$680.88
|
| Rate for Payer: Multiplan Commercial |
$2,269.60
|
| Rate for Payer: Networks By Design Commercial |
$1,844.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,411.45
|
|
|
HC ELECTROLYTE PANEL
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 80051
|
| Hospital Charge Code |
900912165
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$64.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$58.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.00
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.52
|
| Rate for Payer: Dignity Health Media |
$7.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.01
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$11.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.39
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.68
|
| Rate for Payer: United Healthcare All Other HMO |
$5.68
|
| Rate for Payer: United Healthcare HMO Rider |
$5.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Vantage Medical Group Senior |
$7.01
|
|
|
HC ELECTROMYOGRAPHY NEEDLE/LARYNX
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 95865
|
| Hospital Charge Code |
900600240
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$117.84 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$263.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.54
|
| Rate for Payer: Blue Distinction Transplant |
$294.60
|
| Rate for Payer: Blue Shield of California Commercial |
$290.18
|
| Rate for Payer: Blue Shield of California EPN |
$230.28
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cigna of CA HMO |
$314.24
|
| Rate for Payer: Cigna of CA PPO |
$363.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$368.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$261.74
|
| Rate for Payer: Heritage Provider Network Transplant |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$258.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$327.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
