|
HC FLUORO XM G/COLON TUBE
|
Facility
|
OP
|
$2,093.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$268.09 |
| 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 |
$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 |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,255.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$941.85
|
| Rate for Payer: Cash Price |
$941.85
|
| Rate for Payer: Cigna of CA PPO |
$1,548.82
|
| 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 |
$1,779.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,255.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,569.75
|
| 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 |
$1,396.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.32
|
| 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 |
$1,674.40
|
| Rate for Payer: Networks By Design Commercial |
$1,360.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,779.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,255.80
|
| 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 |
$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
|
OP
|
$2,093.00
|
|
|
Service Code
|
CPT 49465
|
| Hospital Charge Code |
906749465
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$268.09 |
| 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 |
$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 |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,255.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$941.85
|
| Rate for Payer: Cash Price |
$941.85
|
| Rate for Payer: Cigna of CA PPO |
$1,548.82
|
| 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 |
$1,779.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,255.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,569.75
|
| 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 |
$1,396.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.32
|
| 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 |
$1,674.40
|
| Rate for Payer: Networks By Design Commercial |
$1,360.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,779.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,255.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.39
|
| 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 |
$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
|
750
|
| 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
|
|
|
HC FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$188.12 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| 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 |
$805.52
|
| Rate for Payer: Blue Distinction Transplant |
$811.20
|
| Rate for Payer: Blue Shield of California Commercial |
$799.03
|
| Rate for Payer: Blue Shield of California EPN |
$634.09
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna of CA HMO |
$865.28
|
| Rate for Payer: Cigna of CA PPO |
$1,000.48
|
| 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 |
$1,149.20
|
| Rate for Payer: Global Benefits Group Commercial |
$811.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,014.00
|
| 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 |
$901.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.48
|
| 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 |
$1,081.60
|
| Rate for Payer: Networks By Design Commercial |
$878.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| 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 FMRI BRAIN BY PHYS/PSYCH
|
Facility
|
IP
|
$2,409.00
|
|
|
Service Code
|
CPT 70555
|
| Hospital Charge Code |
908801023
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$578.16 |
| Max. Negotiated Rate |
$2,047.65 |
| Rate for Payer: Cash Price |
$1,084.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.60
|
| Rate for Payer: Galaxy Health WC |
$2,047.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,445.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,606.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.16
|
| Rate for Payer: Multiplan Commercial |
$1,927.20
|
| Rate for Payer: Networks By Design Commercial |
$1,565.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,047.65
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
IP
|
$1,927.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$462.48 |
| Max. Negotiated Rate |
$1,637.95 |
| Rate for Payer: Cash Price |
$867.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.80
|
| Rate for Payer: Galaxy Health WC |
$1,637.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,156.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,285.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.48
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: Networks By Design Commercial |
$1,252.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.95
|
|
|
HC FMRI BRAIN BY TECH
|
Facility
|
OP
|
$1,352.00
|
|
|
Service Code
|
CPT 70554
|
| Hospital Charge Code |
908801022
|
|
Hospital Revenue Code
|
611
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,328.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,328.99
|
| 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 |
$805.52
|
| Rate for Payer: Blue Distinction Transplant |
$811.20
|
| Rate for Payer: Blue Shield of California Commercial |
$799.03
|
| Rate for Payer: Blue Shield of California EPN |
$634.09
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cash Price |
$608.40
|
| Rate for Payer: Cigna of CA HMO |
$865.28
|
| Rate for Payer: Cigna of CA PPO |
$1,000.48
|
| 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 |
$1,149.20
|
| Rate for Payer: Global Benefits Group Commercial |
$811.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,014.00
|
| 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 |
$901.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.48
|
| 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 |
$1,081.60
|
| Rate for Payer: Networks By Design Commercial |
$878.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,149.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$866.34
|
| Rate for Payer: United Healthcare All Other HMO |
$866.34
|
| Rate for Payer: United Healthcare HMO Rider |
$866.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$866.34
|
| 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 FNA BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$2,146.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.21 |
| 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 |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,287.60
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cigna of CA PPO |
$1,588.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,824.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,609.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,424.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,431.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,716.80
|
| Rate for Payer: Networks By Design Commercial |
$1,394.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,824.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,287.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$2,146.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$515.04 |
| Max. Negotiated Rate |
$1,824.10 |
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$858.40
|
| Rate for Payer: Galaxy Health WC |
$1,824.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,431.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$817.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$515.04
|
| Rate for Payer: Multiplan Commercial |
$1,716.80
|
| Rate for Payer: Networks By Design Commercial |
$1,394.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,824.10
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$257.52 |
| Max. Negotiated Rate |
$912.05 |
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.20
|
| Rate for Payer: Galaxy Health WC |
$912.05
|
| Rate for Payer: Global Benefits Group Commercial |
$643.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.52
|
| Rate for Payer: Multiplan Commercial |
$858.40
|
| Rate for Payer: Networks By Design Commercial |
$697.45
|
| Rate for Payer: Prime Health Services Commercial |
$912.05
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.32 |
| 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 |
$912.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$643.80
|
| 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 |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cigna of CA PPO |
$794.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.05
|
| Rate for Payer: Dignity Health Media |
$912.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$429.20
|
| Rate for Payer: Galaxy Health WC |
$912.05
|
| Rate for Payer: Global Benefits Group Commercial |
$643.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$804.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.52
|
| Rate for Payer: Multiplan Commercial |
$858.40
|
| Rate for Payer: Networks By Design Commercial |
$697.45
|
| Rate for Payer: Prime Health Services Commercial |
$912.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$643.80
|
| 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 |
$912.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.05
|
| Rate for Payer: Vantage Medical Group Senior |
$912.05
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$132.60 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$37.44 |
| Max. Negotiated Rate |
$440.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$440.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.75
|
| Rate for Payer: Blue Distinction Transplant |
$93.60
|
| Rate for Payer: Blue Shield of California Commercial |
$100.78
|
| Rate for Payer: Blue Shield of California EPN |
$79.87
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$134.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.15
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: Dignity Health Media |
$14.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.70
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$24.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.70
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.91
|
| Rate for Payer: United Healthcare All Other HMO |
$11.91
|
| Rate for Payer: United Healthcare HMO Rider |
$11.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$14.70
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.23 |
| Max. Negotiated Rate |
$6,531.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$481.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.19
|
| Rate for Payer: Blue Distinction Transplant |
$1,605.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,581.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,255.04
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cigna of CA HMO |
$1,712.64
|
| Rate for Payer: Cigna of CA PPO |
$1,980.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$2,274.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,007.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,531.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,451.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,018.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: Networks By Design Commercial |
$1,739.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,274.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,605.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,605.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
IP
|
$2,676.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$642.24 |
| Max. Negotiated Rate |
$2,274.60 |
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,070.40
|
| Rate for Payer: Galaxy Health WC |
$2,274.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,784.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,019.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$642.24
|
| Rate for Payer: Multiplan Commercial |
$2,140.80
|
| Rate for Payer: Networks By Design Commercial |
$1,739.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,274.60
|
|
|
HC FOOT COMPLETE
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.02 |
| Max. Negotiated Rate |
$772.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$148.29
|
| 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 |
$138.45
|
| Rate for Payer: Blue Distinction Transplant |
$545.40
|
| Rate for Payer: Blue Shield of California Commercial |
$537.22
|
| Rate for Payer: Blue Shield of California EPN |
$426.32
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Cigna of CA HMO |
$581.76
|
| Rate for Payer: Cigna of CA PPO |
$672.66
|
| 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 |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$681.75
|
| 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 |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.16
|
| 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 |
$727.20
|
| Rate for Payer: Networks By Design Commercial |
$590.85
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$545.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$545.40
|
| 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 FOOT COMPLETE
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT 73630
|
| Hospital Charge Code |
909001631
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.16 |
| Max. Negotiated Rate |
$772.65 |
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.16
|
| Rate for Payer: Multiplan Commercial |
$727.20
|
| Rate for Payer: Networks By Design Commercial |
$590.85
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
|
|
HC FOOT LIMITED 2 VIEWS
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.44
|
| 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 |
$128.74
|
| Rate for Payer: Blue Distinction Transplant |
$423.60
|
| Rate for Payer: Blue Shield of California Commercial |
$417.25
|
| Rate for Payer: Blue Shield of California EPN |
$331.11
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: Cigna of CA HMO |
$451.84
|
| Rate for Payer: Cigna of CA PPO |
$522.44
|
| 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 |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$529.50
|
| 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 |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| 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 |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$423.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$423.60
|
| 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 FOOT LIMITED 2 VIEWS
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
909001632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$169.44 |
| Max. Negotiated Rate |
$600.10 |
| Rate for Payer: Cash Price |
$317.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$600.10
|
| Rate for Payer: Global Benefits Group Commercial |
$423.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$470.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.44
|
| Rate for Payer: Multiplan Commercial |
$564.80
|
| Rate for Payer: Networks By Design Commercial |
$458.90
|
| Rate for Payer: Prime Health Services Commercial |
$600.10
|
|
|
HC FOREARM
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
909001513
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$617.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126.60
|
| 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 |
$435.60
|
| Rate for Payer: Blue Shield of California Commercial |
$429.07
|
| Rate for Payer: Blue Shield of California EPN |
$340.49
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cigna of CA HMO |
$464.64
|
| Rate for Payer: Cigna of CA PPO |
$537.24
|
| 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 |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$544.50
|
| 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 |
$484.24
|
| 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 |
$174.24
|
| 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 |
$580.80
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$435.60
|
| 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 FOREARM
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
CPT 73090
|
| Hospital Charge Code |
909001513
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$617.10 |
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.40
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.24
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
|
|
HC FOREIGN BODY NOSE/RECTUM CHILD
|
Facility
|
OP
|
$288.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
909001710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.35 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$117.98
|
| 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 |
$144.16
|
| Rate for Payer: Blue Distinction Transplant |
$172.80
|
| Rate for Payer: Blue Shield of California Commercial |
$170.21
|
| Rate for Payer: Blue Shield of California EPN |
$135.07
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$184.32
|
| Rate for Payer: Cigna of CA PPO |
$213.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$216.00
|
| 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 |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| 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 |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$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 FOREIGN BODY NOSE/RECTUM CHILD
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 76010
|
| Hospital Charge Code |
909001710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.12 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC FORESKIN MANIPULATION
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
908710164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.79 |
| 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 |
$463.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$918.60
|
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: Cigna of CA PPO |
$1,132.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.18
|
| Rate for Payer: Dignity Health Media |
$308.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$308.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$308.79
|
| Rate for Payer: Galaxy Health WC |
$1,301.35
|
| Rate for Payer: Global Benefits Group Commercial |
$918.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,148.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$506.42
|
| 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 |
$308.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,021.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$583.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$308.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$367.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$413.78
|
| Rate for Payer: Multiplan Commercial |
$1,224.80
|
| Rate for Payer: Networks By Design Commercial |
$995.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,301.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$765.50
|
| Rate for Payer: United Healthcare All Other HMO |
$765.50
|
| Rate for Payer: United Healthcare HMO Rider |
$765.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$765.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.67
|
| Rate for Payer: Vantage Medical Group Senior |
$308.79
|
|
