|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.96
|
| Rate for Payer: Blue Distinction Transplant |
$234.60
|
| Rate for Payer: Blue Shield of California Commercial |
$288.17
|
| Rate for Payer: Blue Shield of California EPN |
$228.34
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Media |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$293.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.96
|
| Rate for Payer: Blue Distinction Transplant |
$234.60
|
| Rate for Payer: Blue Shield of California Commercial |
$288.17
|
| Rate for Payer: Blue Shield of California EPN |
$228.34
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Media |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$293.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947300200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.96
|
| Rate for Payer: Blue Distinction Transplant |
$234.60
|
| 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 |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Media |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$293.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947300200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.96
|
| Rate for Payer: Blue Distinction Transplant |
$234.60
|
| Rate for Payer: Blue Shield of California Commercial |
$288.17
|
| Rate for Payer: Blue Shield of California EPN |
$228.34
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Media |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$293.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR OSCP
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
946100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$93.84 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR OSCP
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
946100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.96
|
| Rate for Payer: Blue Distinction Transplant |
$234.60
|
| 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 |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cash Price |
$175.95
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Media |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$293.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.32 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$154.32 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$442.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.10
|
| Rate for Payer: Blue Distinction Transplant |
$385.80
|
| Rate for Payer: Blue Shield of California Commercial |
$473.89
|
| Rate for Payer: Blue Shield of California EPN |
$375.51
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.55
|
| Rate for Payer: Dignity Health Media |
$546.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$482.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.55
|
| Rate for Payer: Vantage Medical Group Senior |
$546.55
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$442.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.10
|
| Rate for Payer: Blue Distinction Transplant |
$385.80
|
| Rate for Payer: Blue Shield of California Commercial |
$473.89
|
| Rate for Payer: Blue Shield of California EPN |
$375.51
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.55
|
| Rate for Payer: Dignity Health Media |
$546.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$482.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.55
|
| Rate for Payer: Vantage Medical Group Senior |
$546.55
|
|
|
HC ESTRADIOL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$254.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$232.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.97
|
| Rate for Payer: Blue Distinction Transplant |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$56.85
|
| Rate for Payer: Blue Shield of California EPN |
$45.06
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.91
|
| Rate for Payer: Dignity Health Media |
$27.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.94
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.82
|
| Rate for Payer: Heritage Provider Network Transplant |
$45.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$45.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.64
|
| Rate for Payer: United Healthcare All Other HMO |
$22.64
|
| Rate for Payer: United Healthcare HMO Rider |
$22.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Vantage Medical Group Senior |
$27.94
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$573.75 |
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.00
|
| Rate for Payer: Galaxy Health WC |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.22 |
| 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 |
$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 |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$405.00
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cash Price |
$303.75
|
| Rate for Payer: Cigna of CA PPO |
$499.50
|
| 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 |
$573.75
|
| Rate for Payer: Global Benefits Group Commercial |
$405.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$506.25
|
| 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 |
$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 |
$159.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$450.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| 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 |
$540.00
|
| Rate for Payer: Networks By Design Commercial |
$438.75
|
| Rate for Payer: Prime Health Services Commercial |
$573.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.50
|
| Rate for Payer: United Healthcare All Other HMO |
$337.50
|
| Rate for Payer: United Healthcare HMO Rider |
$337.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.50
|
| 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
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
OP
|
$7,277.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$577.64 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,366.20
|
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: Cigna of CA PPO |
$5,384.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,185.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,366.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,457.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| 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 |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,853.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,746.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$5,821.60
|
| Rate for Payer: Networks By Design Commercial |
$4,730.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,185.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,366.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,638.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,638.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,638.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,638.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$7,277.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,746.48 |
| Max. Negotiated Rate |
$6,185.45 |
| Rate for Payer: Cash Price |
$3,274.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,910.80
|
| Rate for Payer: Galaxy Health WC |
$6,185.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,366.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,853.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,772.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,746.48
|
| Rate for Payer: Multiplan Commercial |
$5,821.60
|
| Rate for Payer: Networks By Design Commercial |
$4,730.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,185.45
|
|
|
HC EVAL OF FNA,EA ADDLL SITE PG
|
Facility
|
OP
|
$14.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800217
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$41.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.09
|
| Rate for Payer: Blue Distinction Transplant |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9.04
|
| Rate for Payer: Blue Shield of California EPN |
$7.17
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: Dignity Health Media |
$11.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$11.20
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.89
|
| Rate for Payer: United Healthcare All Other HMO |
$5.89
|
| Rate for Payer: United Healthcare HMO Rider |
$5.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
HC EVAL OF FNA,EA ADDLL SITE PG
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800217
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$11.20
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
|
HC EVAL OF FNA INITIAL PG
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800216
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$53.75 |
| Max. Negotiated Rate |
$349.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$130.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.90
|
| Rate for Payer: Blue Distinction Transplant |
$193.20
|
| Rate for Payer: Blue Shield of California Commercial |
$208.01
|
| Rate for Payer: Blue Shield of California EPN |
$164.86
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: Cigna of CA HMO |
$206.08
|
| Rate for Payer: Cigna of CA PPO |
$238.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$241.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$349.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$345.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$345.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC EVAL OF FNA INITIAL PG
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 88172
|
| Hospital Charge Code |
903800216
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$273.70 |
| Rate for Payer: Cash Price |
$144.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.80
|
| Rate for Payer: Galaxy Health WC |
$273.70
|
| Rate for Payer: Global Benefits Group Commercial |
$193.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$214.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Networks By Design Commercial |
$209.30
|
| Rate for Payer: Prime Health Services Commercial |
$273.70
|
|
|
HC EVAL/REVAL FOR PRESCRIPT SPCH DEVICE MCAL
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 92605
|
| Hospital Charge Code |
907000025
|
|
Hospital Revenue Code
|
444
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$479.40 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.60
|
| Rate for Payer: Galaxy Health WC |
$479.40
|
| Rate for Payer: Global Benefits Group Commercial |
$338.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.36
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: Networks By Design Commercial |
$366.60
|
| Rate for Payer: Prime Health Services Commercial |
$479.40
|
|
