|
HC GLUCOSE BODY FLUID
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.75
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Media |
$3.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE CSF
|
Facility
|
OP
|
$11.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910305
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.75
|
| Rate for Payer: Blue Distinction Transplant |
$6.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California EPN |
$5.63
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cash Price |
$4.95
|
| Rate for Payer: Cigna of CA HMO |
$7.04
|
| Rate for Payer: Cigna of CA PPO |
$8.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Media |
$3.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$9.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Networks By Design Commercial |
$7.15
|
| Rate for Payer: Prime Health Services Commercial |
$9.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE FASTING
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
900910306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.87
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Media |
$3.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE LOADING 1 HR
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
900910314
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$43.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.30
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC GLUCOSE MONITORING MIN 72 HRS
|
Facility
|
IP
|
$1,381.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
902501910
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$331.44 |
| Max. Negotiated Rate |
$1,173.85 |
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$552.40
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
|
|
HC GLUCOSE MONITORING MIN 72 HRS
|
Facility
|
OP
|
$1,381.00
|
|
|
Service Code
|
CPT 95250
|
| Hospital Charge Code |
902501910
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$165.16 |
| Max. Negotiated Rate |
$1,173.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,020.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$822.80
|
| Rate for Payer: Blue Distinction Transplant |
$828.60
|
| Rate for Payer: Blue Shield of California Commercial |
$816.17
|
| Rate for Payer: Blue Shield of California EPN |
$647.69
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cash Price |
$621.45
|
| Rate for Payer: Cigna of CA HMO |
$883.84
|
| Rate for Payer: Cigna of CA PPO |
$1,021.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.74
|
| Rate for Payer: Dignity Health Media |
$165.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.97
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$165.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$165.16
|
| Rate for Payer: Galaxy Health WC |
$1,173.85
|
| Rate for Payer: Global Benefits Group Commercial |
$828.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,035.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$270.86
|
| Rate for Payer: Heritage Provider Network Transplant |
$270.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$267.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$267.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$921.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.31
|
| Rate for Payer: Multiplan Commercial |
$1,104.80
|
| Rate for Payer: Networks By Design Commercial |
$897.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,173.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$828.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$828.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.68
|
| Rate for Payer: Vantage Medical Group Senior |
$165.16
|
|
|
HC GLUCOSE RANDOM
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
900910307
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$35.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.87
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Media |
$3.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE TESTING POC
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 82962
|
| Hospital Charge Code |
900910468
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$19.47 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.28
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.92
|
| Rate for Payer: Dignity Health Media |
$3.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.28
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$5.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$5.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.66
|
| Rate for Payer: United Healthcare All Other HMO |
$2.66
|
| Rate for Payer: United Healthcare HMO Rider |
$2.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.61
|
| Rate for Payer: Vantage Medical Group Senior |
$3.28
|
|
|
HC GLUCOSE TEST STRIP
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
908600850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC GLUCOSE TEST STRIP
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
908600850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.81
|
| Rate for Payer: Blue Distinction Transplant |
$103.20
|
| Rate for Payer: Blue Shield of California Commercial |
$111.11
|
| Rate for Payer: Blue Shield of California EPN |
$88.06
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.56
|
| Rate for Payer: Dignity Health Media |
$5.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.04
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$8.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$8.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.09
|
| Rate for Payer: United Healthcare All Other HMO |
$4.09
|
| Rate for Payer: United Healthcare HMO Rider |
$4.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.54
|
| Rate for Payer: Vantage Medical Group Senior |
$5.04
|
|
|
HC GLUCOSE TOLERANCE TEST 2 HR
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$117.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.44
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.09
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Media |
$12.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE TOLERANCE TEST 3 HR
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$117.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.44
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.09
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Media |
$12.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE URINE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$35.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.75
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10.34
|
| Rate for Payer: Blue Shield of California EPN |
$8.19
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Media |
$3.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
|
IP
|
$6,165.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,479.60 |
| Max. Negotiated Rate |
$5,240.25 |
| Rate for Payer: Cash Price |
$2,774.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,466.00
|
| Rate for Payer: Galaxy Health WC |
$5,240.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,699.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,348.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,479.60
|
| Rate for Payer: Multiplan Commercial |
$4,932.00
|
| Rate for Payer: Networks By Design Commercial |
$4,007.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,240.25
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
|
OP
|
$6,165.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.46 |
| 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 |
$3,699.00
|
| Rate for Payer: Cash Price |
$2,774.25
|
| Rate for Payer: Cash Price |
$2,774.25
|
| Rate for Payer: Cash Price |
$2,774.25
|
| Rate for Payer: Cigna of CA PPO |
$4,562.10
|
| 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 |
$5,240.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,699.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,623.75
|
| 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 |
$4,112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,479.60
|
| 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 |
$4,932.00
|
| Rate for Payer: Networks By Design Commercial |
$4,007.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,240.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,699.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,082.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,082.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,082.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,082.50
|
| 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 GRAFT DERMA-FAT-FASCIA
|
Facility
|
IP
|
$5,118.00
|
|
|
Service Code
|
CPT 15770
|
| Hospital Charge Code |
900501750
|
|
Hospital Revenue Code
|
451
|
| Min. Negotiated Rate |
$1,228.32 |
| Max. Negotiated Rate |
$4,350.30 |
| Rate for Payer: Cash Price |
$2,303.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,047.20
|
| Rate for Payer: Galaxy Health WC |
$4,350.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,070.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,413.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,949.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,228.32
|
| Rate for Payer: Multiplan Commercial |
$4,094.40
|
| Rate for Payer: Networks By Design Commercial |
$3,326.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,350.30
|
|
|
HC GRAFT DERMA-FAT-FASCIA
|
Facility
|
OP
|
$5,118.00
|
|
|
Service Code
|
CPT 15770
|
| Hospital Charge Code |
900501750
|
|
Hospital Revenue Code
|
451
|
| Min. Negotiated Rate |
$848.84 |
| 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 |
$6,723.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,482.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,070.80
|
| Rate for Payer: Cash Price |
$2,303.10
|
| Rate for Payer: Cash Price |
$2,303.10
|
| Rate for Payer: Cash Price |
$2,303.10
|
| Rate for Payer: Cigna of CA PPO |
$3,787.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Dignity Health Media |
$4,482.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,051.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,482.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,482.50
|
| Rate for Payer: Galaxy Health WC |
$4,350.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,070.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,838.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,351.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,351.30
|
| 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 |
$4,482.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,413.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,482.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,228.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,647.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,006.55
|
| Rate for Payer: Multiplan Commercial |
$4,094.40
|
| Rate for Payer: Networks By Design Commercial |
$3,326.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,350.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,070.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,070.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,559.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,559.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,559.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,559.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,482.50
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906811413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$176.88 |
| Max. Negotiated Rate |
$626.45 |
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.88
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906811413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$474.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$442.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cigna of CA PPO |
$545.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Media |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$552.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.88
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.20
|
| 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 |
$626.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC GRAM POSITIVE SENSITIVITY MIC
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.87
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.26
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: Dignity Health Media |
$8.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC GRAM STAIN
|
Facility
|
OP
|
$13.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
900911705
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.12 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.94
|
| Rate for Payer: Blue Distinction Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.40
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC GROUP THERAPY 60 MIN
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
903100090
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$45.52 |
| Max. Negotiated Rate |
$341.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$285.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.51
|
| Rate for Payer: Blue Distinction Transplant |
$241.20
|
| Rate for Payer: Blue Shield of California Commercial |
$296.27
|
| Rate for Payer: Blue Shield of California EPN |
$234.77
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna of CA HMO |
$257.28
|
| Rate for Payer: Cigna of CA PPO |
$297.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.06
|
| Rate for Payer: Dignity Health Media |
$111.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$111.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.37
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$301.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$182.65
|
| Rate for Payer: Heritage Provider Network Transplant |
$182.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$180.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$180.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.24
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.00
|
| Rate for Payer: United Healthcare All Other HMO |
$201.00
|
| Rate for Payer: United Healthcare HMO Rider |
$201.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.51
|
| Rate for Payer: Vantage Medical Group Senior |
$111.37
|
|
|
HC GROUP THERAPY 60 MIN
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
903100090
|
|
Hospital Revenue Code
|
915
|
| Min. Negotiated Rate |
$96.48 |
| Max. Negotiated Rate |
$341.70 |
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.48
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$263.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$179.34
|
| Rate for Payer: Blue Distinction Transplant |
$180.60
|
| Rate for Payer: Blue Shield of California Commercial |
$177.89
|
| Rate for Payer: Blue Shield of California EPN |
$141.17
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: Cigna of CA HMO |
$192.64
|
| Rate for Payer: Cigna of CA PPO |
$222.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.85
|
| Rate for Payer: Dignity Health Media |
$255.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$225.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.24
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.85
|
| Rate for Payer: Vantage Medical Group Senior |
$255.85
|
|
|
HC GUIDE NERV DESTR, ELEC STIM
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
900600242
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$255.85 |
| Rate for Payer: Cash Price |
$135.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.40
|
| Rate for Payer: Galaxy Health WC |
$255.85
|
| Rate for Payer: Global Benefits Group Commercial |
$180.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.24
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: Networks By Design Commercial |
$195.65
|
| Rate for Payer: Prime Health Services Commercial |
$255.85
|
|
