|
HC FISH PROBE CYTOGEN 10-30 CELLS
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900918009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$1,733.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$267.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,733.63
|
| Rate for Payer: Blue Distinction Transplant |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$94.32
|
| Rate for Payer: Blue Shield of California EPN |
$74.75
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna of CA HMO |
$93.44
|
| Rate for Payer: Cigna of CA PPO |
$108.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.22
|
| Rate for Payer: Dignity Health Media |
$34.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$34.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.81
|
| Rate for Payer: Galaxy Health WC |
$124.10
|
| Rate for Payer: Global Benefits Group Commercial |
$87.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$109.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.09
|
| Rate for Payer: Heritage Provider Network Transplant |
$57.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$56.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$56.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$34.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$97.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.65
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Networks By Design Commercial |
$94.90
|
| Rate for Payer: Prime Health Services Commercial |
$124.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.20
|
| Rate for Payer: United Healthcare All Other HMO |
$28.20
|
| Rate for Payer: United Healthcare HMO Rider |
$28.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.29
|
| Rate for Payer: Vantage Medical Group Senior |
$34.81
|
|
|
HC FISH PROBE CYTOGEN 10-30 CELLS
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
900918009
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.44 |
| Max. Negotiated Rate |
$175.10 |
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.40
|
| Rate for Payer: Galaxy Health WC |
$175.10
|
| Rate for Payer: Global Benefits Group Commercial |
$123.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$137.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.44
|
| Rate for Payer: Multiplan Commercial |
$164.80
|
| Rate for Payer: Networks By Design Commercial |
$133.90
|
| Rate for Payer: Prime Health Services Commercial |
$175.10
|
|
|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.16 |
| Max. Negotiated Rate |
$1,627.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$222.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,627.49
|
| Rate for Payer: Blue Distinction Transplant |
$80.40
|
| Rate for Payer: Blue Shield of California Commercial |
$86.56
|
| Rate for Payer: Blue Shield of California EPN |
$68.61
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.05
|
| Rate for Payer: Dignity Health Media |
$40.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$40.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.70
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$100.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$66.75
|
| Rate for Payer: Heritage Provider Network Transplant |
$66.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$65.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$40.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.97
|
| Rate for Payer: United Healthcare All Other HMO |
$32.97
|
| Rate for Payer: United Healthcare HMO Rider |
$32.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.77
|
| Rate for Payer: Vantage Medical Group Senior |
$40.70
|
|
|
HC FISH PROBE CYTOGEN 3-5 CELLS
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 88272
|
| Hospital Charge Code |
900918008
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$44.64 |
| Max. Negotiated Rate |
$158.10 |
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$74.40
|
| Rate for Payer: Galaxy Health WC |
$158.10
|
| Rate for Payer: Global Benefits Group Commercial |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$124.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.64
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Networks By Design Commercial |
$120.90
|
| Rate for Payer: Prime Health Services Commercial |
$158.10
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$52.32 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC FISH PROBE CYTOGEN EA
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
900918007
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.35 |
| Max. Negotiated Rate |
$1,547.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$178.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,547.88
|
| Rate for Payer: Blue Distinction Transplant |
$94.20
|
| Rate for Payer: Blue Shield of California Commercial |
$101.42
|
| Rate for Payer: Blue Shield of California EPN |
$80.38
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$100.48
|
| Rate for Payer: Cigna of CA PPO |
$116.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.13
|
| Rate for Payer: Dignity Health Media |
$21.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$23.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$21.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.42
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$117.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$35.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$34.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$21.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.35
|
| Rate for Payer: United Healthcare All Other HMO |
$17.35
|
| Rate for Payer: United Healthcare HMO Rider |
$17.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23.56
|
| Rate for Payer: Vantage Medical Group Senior |
$21.42
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.64 |
| 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 |
$306.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$216.60
|
| 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 |
$162.45
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: Cigna of CA PPO |
$267.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.85
|
| Rate for Payer: Dignity Health Media |
$306.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$306.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$144.40
|
| Rate for Payer: Galaxy Health WC |
$306.85
|
| Rate for Payer: Global Benefits Group Commercial |
$216.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$270.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.64
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: Networks By Design Commercial |
$234.65
|
| Rate for Payer: Prime Health Services Commercial |
$306.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$216.60
|
| 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 |
$306.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$306.85
|
| Rate for Payer: Vantage Medical Group Senior |
$306.85
|
|
|
HC FISTULA/SINUS TRACT INJ
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 20501
|
| Hospital Charge Code |
909000108
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.64 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Cash Price |
$162.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$144.40
|
| Rate for Payer: Galaxy Health WC |
$306.85
|
| Rate for Payer: Global Benefits Group Commercial |
$216.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$240.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.64
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: Networks By Design Commercial |
$234.65
|
| Rate for Payer: Prime Health Services Commercial |
$306.85
|
|
|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
|
OP
|
$566.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$129.31 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$339.60
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna of CA PPO |
$418.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$424.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$408.31
|
| 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 |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.00
|
| Rate for Payer: United Healthcare All Other HMO |
$283.00
|
| Rate for Payer: United Healthcare HMO Rider |
$283.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC FIT & INSERT PESSARY SUPPORT D
|
Facility
|
IP
|
$566.00
|
|
|
Service Code
|
CPT 57160
|
| Hospital Charge Code |
900501760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$135.84 |
| Max. Negotiated Rate |
$481.10 |
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.40
|
| Rate for Payer: Galaxy Health WC |
$481.10
|
| Rate for Payer: Global Benefits Group Commercial |
$339.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$377.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.84
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Networks By Design Commercial |
$367.90
|
| Rate for Payer: Prime Health Services Commercial |
$481.10
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
IP
|
$14,372.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,449.28 |
| Max. Negotiated Rate |
$12,216.20 |
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,748.80
|
| Rate for Payer: Galaxy Health WC |
$12,216.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,623.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,586.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,475.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,449.28
|
| Rate for Payer: Multiplan Commercial |
$11,497.60
|
| Rate for Payer: Networks By Design Commercial |
$9,341.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,216.20
|
|
|
HC FIXATION OF DISTAL RADIAL FX
|
Facility
|
OP
|
$14,372.00
|
|
|
Service Code
|
CPT 25606
|
| Hospital Charge Code |
900501394
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$12,216.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$8,623.20
|
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Cash Price |
$6,467.40
|
| Rate for Payer: Cigna of CA PPO |
$10,635.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$12,216.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,623.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,779.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,586.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$987.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,449.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$11,497.60
|
| Rate for Payer: Networks By Design Commercial |
$9,341.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,216.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,623.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,186.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC FK 506 (TACROLIMUS)
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
900911039
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$135.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.38
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.60
|
| Rate for Payer: Dignity Health Media |
$13.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.73
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$114.96 |
| Max. Negotiated Rate |
$407.15 |
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$191.60
|
| Rate for Payer: Galaxy Health WC |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$319.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$182.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.96
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
|
|
HC FLOW VOLUME STUDY
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
900801022
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$44.12 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$162.82
|
| 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 |
$285.39
|
| Rate for Payer: Blue Distinction Transplant |
$287.40
|
| Rate for Payer: Blue Shield of California Commercial |
$283.09
|
| Rate for Payer: Blue Shield of California EPN |
$224.65
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cash Price |
$215.55
|
| Rate for Payer: Cigna of CA HMO |
$306.56
|
| Rate for Payer: Cigna of CA PPO |
$354.46
|
| 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 |
$407.15
|
| Rate for Payer: Global Benefits Group Commercial |
$287.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$359.25
|
| 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 |
$319.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.96
|
| 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 |
$383.20
|
| Rate for Payer: Networks By Design Commercial |
$311.35
|
| Rate for Payer: Prime Health Services Commercial |
$407.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$287.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$287.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| 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 FLUORESCENT STAIN FUNGI
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
900912418
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.36 |
| Max. Negotiated Rate |
$49.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.02
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Media |
$5.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.39
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.84
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.22
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.36
|
| Rate for Payer: United Healthcare All Other HMO |
$4.36
|
| Rate for Payer: United Healthcare HMO Rider |
$4.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.93
|
| Rate for Payer: Vantage Medical Group Senior |
$5.39
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
OP
|
$1,340.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.76 |
| Max. Negotiated Rate |
$1,139.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$607.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,139.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$737.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$737.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$346.55
|
| Rate for Payer: Blue Distinction Transplant |
$804.00
|
| Rate for Payer: Blue Shield of California Commercial |
$791.94
|
| Rate for Payer: Blue Shield of California EPN |
$628.46
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: Cigna of CA HMO |
$857.60
|
| Rate for Payer: Cigna of CA PPO |
$991.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,139.00
|
| Rate for Payer: Dignity Health Media |
$1,139.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$536.00
|
| Rate for Payer: Galaxy Health WC |
$1,139.00
|
| Rate for Payer: Global Benefits Group Commercial |
$804.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,005.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: Networks By Design Commercial |
$871.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$804.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$804.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$670.00
|
| Rate for Payer: United Healthcare All Other HMO |
$670.00
|
| Rate for Payer: United Healthcare HMO Rider |
$670.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$670.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,139.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,139.00
|
|
|
HC FLUORO GUIDANCE CNTRL VNS ACCESS DVC
|
Facility
|
IP
|
$1,340.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
909081673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$321.60 |
| Max. Negotiated Rate |
$1,139.00 |
| Rate for Payer: Cash Price |
$603.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$536.00
|
| Rate for Payer: Galaxy Health WC |
$1,139.00
|
| Rate for Payer: Global Benefits Group Commercial |
$804.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$893.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$510.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.60
|
| Rate for Payer: Multiplan Commercial |
$1,072.00
|
| Rate for Payer: Networks By Design Commercial |
$871.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,139.00
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
IP
|
$2,024.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$485.76 |
| Max. Negotiated Rate |
$1,720.40 |
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$771.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
|
|
HC FLUORO GUIDE NDL PLCMNT THRPY INJ
|
Facility
|
OP
|
$2,024.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
909001368
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$126.37 |
| Max. Negotiated Rate |
$1,720.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,720.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,113.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$439.18
|
| Rate for Payer: Blue Distinction Transplant |
$1,214.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,196.18
|
| Rate for Payer: Blue Shield of California EPN |
$949.26
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cash Price |
$910.80
|
| Rate for Payer: Cigna of CA HMO |
$1,295.36
|
| Rate for Payer: Cigna of CA PPO |
$1,497.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,720.40
|
| Rate for Payer: Dignity Health Media |
$1,720.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,720.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$809.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$809.60
|
| Rate for Payer: Galaxy Health WC |
$1,720.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,214.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,518.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,350.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$1,619.20
|
| Rate for Payer: Networks By Design Commercial |
$1,315.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,720.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,214.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,214.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,012.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,012.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,012.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,012.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,720.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,720.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,720.40
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
IP
|
$1,442.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$346.08 |
| Max. Negotiated Rate |
$1,225.70 |
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.80
|
| Rate for Payer: Galaxy Health WC |
$1,225.70
|
| Rate for Payer: Global Benefits Group Commercial |
$865.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$961.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$549.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.08
|
| Rate for Payer: Multiplan Commercial |
$1,153.60
|
| Rate for Payer: Networks By Design Commercial |
$937.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,225.70
|
|
|
HC FLUORO GUIDE SPINE OR PARASPINOUS
|
Facility
|
OP
|
$1,442.00
|
|
|
Service Code
|
CPT 77003
|
| Hospital Charge Code |
909001358
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.07 |
| Max. Negotiated Rate |
$1,225.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$208.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,225.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$793.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$793.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.50
|
| Rate for Payer: Blue Distinction Transplant |
$865.20
|
| Rate for Payer: Blue Shield of California Commercial |
$852.22
|
| Rate for Payer: Blue Shield of California EPN |
$676.30
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cash Price |
$648.90
|
| Rate for Payer: Cigna of CA HMO |
$922.88
|
| Rate for Payer: Cigna of CA PPO |
$1,067.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,225.70
|
| Rate for Payer: Dignity Health Media |
$1,225.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,225.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$576.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$576.80
|
| Rate for Payer: Galaxy Health WC |
$1,225.70
|
| Rate for Payer: Global Benefits Group Commercial |
$865.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,081.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$961.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$346.08
|
| Rate for Payer: Multiplan Commercial |
$1,153.60
|
| Rate for Payer: Networks By Design Commercial |
$937.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,225.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$865.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$865.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$721.00
|
| Rate for Payer: United Healthcare All Other HMO |
$721.00
|
| Rate for Payer: United Healthcare HMO Rider |
$721.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$721.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,225.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,225.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,225.70
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
IP
|
$1,587.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$380.88 |
| Max. Negotiated Rate |
$1,348.95 |
| Rate for Payer: Cash Price |
$714.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$634.80
|
| Rate for Payer: Galaxy Health WC |
$1,348.95
|
| Rate for Payer: Global Benefits Group Commercial |
$952.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,058.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$604.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$1,269.60
|
| Rate for Payer: Networks By Design Commercial |
$1,031.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.95
|
|
|
HC FLUOROSCOPY LT 1HR
|
Facility
|
OP
|
$1,587.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
906811312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.12 |
| Max. Negotiated Rate |
$1,348.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$440.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$296.99
|
| Rate for Payer: Blue Distinction Transplant |
$952.20
|
| Rate for Payer: Blue Shield of California Commercial |
$937.92
|
| Rate for Payer: Blue Shield of California EPN |
$744.30
|
| Rate for Payer: Cash Price |
$714.15
|
| Rate for Payer: Cash Price |
$714.15
|
| Rate for Payer: Cigna of CA HMO |
$1,015.68
|
| Rate for Payer: Cigna of CA PPO |
$1,174.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,348.95
|
| Rate for Payer: Global Benefits Group Commercial |
$952.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,190.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,058.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,269.60
|
| Rate for Payer: Networks By Design Commercial |
$1,031.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$952.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$952.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$225.63
|
| Rate for Payer: United Healthcare All Other HMO |
$225.63
|
| Rate for Payer: United Healthcare HMO Rider |
$225.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$225.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC FLUORO XM G/COLON TUBE
|
Facility
|
IP
|
$3,792.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$910.08 |
| Max. Negotiated Rate |
$3,223.20 |
| Rate for Payer: Cash Price |
$1,706.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,516.80
|
| Rate for Payer: Galaxy Health WC |
$3,223.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,275.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,529.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,444.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$910.08
|
| Rate for Payer: Multiplan Commercial |
$3,033.60
|
| Rate for Payer: Networks By Design Commercial |
$2,464.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,223.20
|
|
