|
HC FORESKIN MANIPULATION
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
CPT 54450
|
| Hospital Charge Code |
908710164
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$367.44 |
| Max. Negotiated Rate |
$1,301.35 |
| Rate for Payer: Cash Price |
$688.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.40
|
| Rate for Payer: Galaxy Health WC |
$1,301.35
|
| Rate for Payer: Global Benefits Group Commercial |
$918.60
|
| 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: LLUH Dept of Risk Management WC |
$367.44
|
| 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
|
|
|
HC FREE T4 BY EIA
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
900912111
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$82.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$75.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.25
|
| 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 |
$13.53
|
| Rate for Payer: Dignity Health Media |
$9.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.18
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$9.02
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.02
|
| 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 |
$14.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.09
|
| 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 |
$7.31
|
| Rate for Payer: United Healthcare All Other HMO |
$7.31
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Vantage Medical Group Senior |
$9.02
|
|
|
HC FROZEN SECTION
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$146.40 |
| Max. Negotiated Rate |
$518.50 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.40
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC FROZEN SECTION
|
Facility
|
OP
|
$149.00
|
|
|
Service Code
|
CPT 88331
|
| Hospital Charge Code |
903800035
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$35.76 |
| Max. Negotiated Rate |
$349.99 |
| Rate for Payer: Aetna of CA HMO/PPO |
$202.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.27
|
| Rate for Payer: Blue Distinction Transplant |
$89.40
|
| Rate for Payer: Blue Shield of California Commercial |
$96.25
|
| Rate for Payer: Blue Shield of California EPN |
$76.29
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cash Price |
$67.05
|
| Rate for Payer: Cigna of CA HMO |
$95.36
|
| Rate for Payer: Cigna of CA PPO |
$110.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.12
|
| Rate for Payer: Dignity Health Media |
$213.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$234.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$288.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$213.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$213.41
|
| Rate for Payer: Galaxy Health WC |
$126.65
|
| Rate for Payer: Global Benefits Group Commercial |
$89.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$349.99
|
| Rate for Payer: Heritage Provider Network Transplant |
$349.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$345.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$345.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$213.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$268.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.97
|
| Rate for Payer: Multiplan Commercial |
$119.20
|
| Rate for Payer: Networks By Design Commercial |
$96.85
|
| Rate for Payer: Prime Health Services Commercial |
$126.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC FSH
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
900910818
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$169.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.53
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23.26
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.87
|
| Rate for Payer: Dignity Health Media |
$18.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.58
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$30.47
|
| Rate for Payer: Heritage Provider Network Transplant |
$30.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$30.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.90
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.05
|
| Rate for Payer: United Healthcare All Other HMO |
$15.05
|
| Rate for Payer: United Healthcare HMO Rider |
$15.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.44
|
| Rate for Payer: Vantage Medical Group Senior |
$18.58
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
OP
|
$4,777.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,866.20
|
| Rate for Payer: Cash Price |
$2,149.65
|
| Rate for Payer: Cash Price |
$2,149.65
|
| Rate for Payer: Cash Price |
$2,149.65
|
| Rate for Payer: Cigna of CA PPO |
$3,534.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,060.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,866.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,582.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| 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 |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,186.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,146.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$3,821.60
|
| Rate for Payer: Networks By Design Commercial |
$3,105.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,060.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,866.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,388.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,388.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,388.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,388.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC FULL THCKNESS GRAFT LT 20SQ CM
|
Facility
|
IP
|
$4,777.00
|
|
|
Service Code
|
CPT 15240
|
| Hospital Charge Code |
900501513
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,146.48 |
| Max. Negotiated Rate |
$4,060.45 |
| Rate for Payer: Cash Price |
$2,149.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,910.80
|
| Rate for Payer: Galaxy Health WC |
$4,060.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,866.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,186.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,820.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,146.48
|
| Rate for Payer: Multiplan Commercial |
$3,821.60
|
| Rate for Payer: Networks By Design Commercial |
$3,105.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,060.45
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
OP
|
$5,686.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,411.60
|
| Rate for Payer: Cash Price |
$2,558.70
|
| Rate for Payer: Cash Price |
$2,558.70
|
| Rate for Payer: Cash Price |
$2,558.70
|
| Rate for Payer: Cigna of CA PPO |
$4,207.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,833.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,411.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,264.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| 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 |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,792.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,364.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$4,548.80
|
| Rate for Payer: Networks By Design Commercial |
$3,695.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,833.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,411.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,843.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,843.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,843.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,843.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC FULL THCKNESS GRAFT,LT 20SQ CM
|
Facility
|
IP
|
$5,686.00
|
|
|
Service Code
|
CPT 15220
|
| Hospital Charge Code |
900501388
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,364.64 |
| Max. Negotiated Rate |
$4,833.10 |
| Rate for Payer: Cash Price |
$2,558.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,274.40
|
| Rate for Payer: Galaxy Health WC |
$4,833.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,411.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,792.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,166.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,364.64
|
| Rate for Payer: Multiplan Commercial |
$4,548.80
|
| Rate for Payer: Networks By Design Commercial |
$3,695.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,833.10
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
OP
|
$4,942.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,965.20
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: Cigna of CA PPO |
$3,657.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,200.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,965.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,706.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| 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 |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,296.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,186.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$3,953.60
|
| Rate for Payer: Networks By Design Commercial |
$3,212.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,200.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,965.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,471.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,471.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,471.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,471.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC FULL THKNS GRFT LT 20SQ CM FCE
|
Facility
|
IP
|
$4,942.00
|
|
|
Service Code
|
CPT 15260
|
| Hospital Charge Code |
900501754
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,186.08 |
| Max. Negotiated Rate |
$4,200.70 |
| Rate for Payer: Cash Price |
$2,223.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,976.80
|
| Rate for Payer: Galaxy Health WC |
$4,200.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,965.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,296.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,882.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,186.08
|
| Rate for Payer: Multiplan Commercial |
$3,953.60
|
| Rate for Payer: Networks By Design Commercial |
$3,212.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,200.70
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
OP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,875.68 |
| Max. Negotiated Rate |
$32,927.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32,927.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,590.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,590.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,138.88
|
| Rate for Payer: Blue Distinction Transplant |
$7,189.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,830.73
|
| Rate for Payer: Blue Shield of California EPN |
$6,997.49
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: Cigna of CA HMO |
$7,668.48
|
| Rate for Payer: Cigna of CA PPO |
$8,866.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Dignity Health Media |
$10,184.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,184.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,986.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,875.68
|
| Rate for Payer: Multiplan Commercial |
$9,585.60
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,189.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,189.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,991.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,991.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,991.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,991.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,184.70
|
| Rate for Payer: Vantage Medical Group Senior |
$10,184.70
|
|
|
HC FUNCTIONAL NEUROMUSCULARSTIM
|
Facility
|
IP
|
$11,982.00
|
|
|
Service Code
|
CPT E0764
|
| Hospital Charge Code |
905360764
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$2,875.68 |
| Max. Negotiated Rate |
$10,184.70 |
| Rate for Payer: Cash Price |
$5,391.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.80
|
| Rate for Payer: Galaxy Health WC |
$10,184.70
|
| Rate for Payer: Global Benefits Group Commercial |
$7,189.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,991.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,565.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,875.68
|
| Rate for Payer: Multiplan Commercial |
$9,585.60
|
| Rate for Payer: Networks By Design Commercial |
$7,788.30
|
| Rate for Payer: Prime Health Services Commercial |
$10,184.70
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
IP
|
$9,884.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,372.16 |
| Max. Negotiated Rate |
$8,401.40 |
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,953.60
|
| Rate for Payer: Galaxy Health WC |
$8,401.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,930.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,592.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,765.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,372.16
|
| Rate for Payer: Multiplan Commercial |
$7,907.20
|
| Rate for Payer: Networks By Design Commercial |
$6,424.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,401.40
|
|
|
HC FUSION OF TENDONS AT WRIST
|
Facility
|
OP
|
$9,884.00
|
|
|
Service Code
|
CPT 25300
|
| Hospital Charge Code |
900501447
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$9,590.00 |
| 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 |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,930.40
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Cash Price |
$4,447.80
|
| Rate for Payer: Cigna of CA PPO |
$7,314.16
|
| 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 |
$8,401.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,930.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,413.00
|
| 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 |
$6,592.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,372.16
|
| 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 |
$7,907.20
|
| Rate for Payer: Networks By Design Commercial |
$6,424.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,401.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,930.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,942.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,942.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,942.00
|
| 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 GADOXETATE DISODIUM PER ML
|
Facility
|
IP
|
$71.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: Blue Shield of California Commercial |
$50.55
|
| Rate for Payer: Blue Shield of California EPN |
$36.35
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.81
|
| Rate for Payer: United Healthcare All Other HMO |
$26.18
|
| Rate for Payer: United Healthcare HMO Rider |
$25.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.43
|
|
|
HC GADOXETATE DISODIUM PER ML
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT A9581
|
| Hospital Charge Code |
908801701
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$60.35 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.71
|
| Rate for Payer: Blue Distinction Transplant |
$42.60
|
| Rate for Payer: Blue Shield of California Commercial |
$41.96
|
| Rate for Payer: Blue Shield of California EPN |
$33.30
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$60.35
|
| Rate for Payer: Dignity Health Media |
$60.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$60.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.40
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$53.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.50
|
| Rate for Payer: United Healthcare All Other HMO |
$35.50
|
| Rate for Payer: United Healthcare HMO Rider |
$35.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$60.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$60.35
|
| Rate for Payer: Vantage Medical Group Senior |
$60.35
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
|
OP
|
$284.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$21.43 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$122.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$170.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna of CA HMO |
$181.76
|
| Rate for Payer: Cigna of CA PPO |
$210.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.40
|
| Rate for Payer: Dignity Health Media |
$241.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$213.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC GAIT TRAINING 15 MIN MCAL
|
Facility
|
IP
|
$284.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
900400037
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
|
OP
|
$3,096.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$2,631.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,877.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,215.44
|
| Rate for Payer: Blue Distinction Transplant |
$1,857.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,829.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,452.02
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: Cigna of CA HMO |
$1,981.44
|
| Rate for Payer: Cigna of CA PPO |
$2,291.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$2,631.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,322.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,476.80
|
| Rate for Payer: Networks By Design Commercial |
$2,012.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,631.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,857.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,857.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$751.01
|
| Rate for Payer: United Healthcare All Other HMO |
$751.01
|
| Rate for Payer: United Healthcare HMO Rider |
$751.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$751.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GALLBLDR/LIVER FUNC
|
Facility
|
IP
|
$3,096.00
|
|
|
Service Code
|
CPT 78226
|
| Hospital Charge Code |
909301353
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$743.04 |
| Max. Negotiated Rate |
$2,631.60 |
| Rate for Payer: Cash Price |
$1,393.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,238.40
|
| Rate for Payer: Galaxy Health WC |
$2,631.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,857.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,065.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,179.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$743.04
|
| Rate for Payer: Multiplan Commercial |
$2,476.80
|
| Rate for Payer: Networks By Design Commercial |
$2,012.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,631.60
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
|
OP
|
$1,842.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$169.33 |
| Max. Negotiated Rate |
$1,565.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$981.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.46
|
| Rate for Payer: Blue Distinction Transplant |
$1,105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,088.62
|
| Rate for Payer: Blue Shield of California EPN |
$863.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cigna of CA HMO |
$1,178.88
|
| Rate for Payer: Cigna of CA PPO |
$1,363.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,565.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,381.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,228.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,473.60
|
| Rate for Payer: Networks By Design Commercial |
$1,197.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,565.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,105.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,105.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$717.15
|
| Rate for Payer: United Healthcare All Other HMO |
$717.15
|
| Rate for Payer: United Healthcare HMO Rider |
$717.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$717.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GALLIUM SCAN LIMITED
|
Facility
|
IP
|
$1,842.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
909301446
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$442.08 |
| Max. Negotiated Rate |
$1,565.70 |
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.80
|
| Rate for Payer: Galaxy Health WC |
$1,565.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,228.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$442.08
|
| Rate for Payer: Multiplan Commercial |
$1,473.60
|
| Rate for Payer: Networks By Design Commercial |
$1,197.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,565.70
|
|
|
HC GAMMA GLUTAMYL TRANSFERASE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
900910225
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$65.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$59.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.97
|
| 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 |
$10.80
|
| Rate for Payer: Dignity Health Media |
$7.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.20
|
| 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 |
$11.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$11.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.65
|
| 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 |
$5.83
|
| Rate for Payer: United Healthcare All Other HMO |
$5.83
|
| Rate for Payer: United Healthcare HMO Rider |
$5.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.92
|
| Rate for Payer: Vantage Medical Group Senior |
$7.20
|
|
|
HC GASTRIC EMPTYING
|
Facility
|
IP
|
$3,393.00
|
|
|
Service Code
|
CPT 78264
|
| Hospital Charge Code |
909301364
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$814.32 |
| Max. Negotiated Rate |
$2,884.05 |
| Rate for Payer: Cash Price |
$1,526.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,357.20
|
| Rate for Payer: Galaxy Health WC |
$2,884.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,035.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,263.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,292.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$814.32
|
| Rate for Payer: Multiplan Commercial |
$2,714.40
|
| Rate for Payer: Networks By Design Commercial |
$2,205.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,884.05
|
|
