|
HC IMMUNOHISTOCHEM OR IMMUNOCYTOCHEM EA ADDITIONAL ABY STAIN
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 88341
|
| Hospital Charge Code |
903800252
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.90 |
| Max. Negotiated Rate |
$551.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$291.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$551.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$356.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$356.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$405.21
|
| Rate for Payer: Blue Distinction Transplant |
$389.40
|
| Rate for Payer: Blue Shield of California Commercial |
$419.25
|
| Rate for Payer: Blue Shield of California EPN |
$332.29
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cigna of CA HMO |
$415.36
|
| Rate for Payer: Cigna of CA PPO |
$480.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$551.65
|
| Rate for Payer: Dignity Health Media |
$551.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$551.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$259.60
|
| Rate for Payer: Galaxy Health WC |
$551.65
|
| Rate for Payer: Global Benefits Group Commercial |
$389.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$486.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$432.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.76
|
| Rate for Payer: Multiplan Commercial |
$519.20
|
| Rate for Payer: Networks By Design Commercial |
$421.85
|
| Rate for Payer: Prime Health Services Commercial |
$551.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$389.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$389.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.90
|
| Rate for Payer: United Healthcare All Other HMO |
$49.90
|
| Rate for Payer: United Healthcare HMO Rider |
$49.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$551.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$551.65
|
| Rate for Payer: Vantage Medical Group Senior |
$551.65
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.08 |
| Max. Negotiated Rate |
$451.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$451.27
|
| 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 |
$339.92
|
| Rate for Payer: Blue Distinction Transplant |
$100.20
|
| Rate for Payer: Blue Shield of California Commercial |
$107.88
|
| Rate for Payer: Blue Shield of California EPN |
$85.50
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| 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 |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$125.25
|
| 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 |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$213.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| 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 |
$133.60
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$234.75
|
| Rate for Payer: Vantage Medical Group Senior |
$213.41
|
|
|
HC IMMUNOHISTOCHEM STAIN ER/PR
|
Facility
|
IP
|
$974.00
|
|
|
Service Code
|
CPT 88360
|
| Hospital Charge Code |
903800179
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$233.76 |
| Max. Negotiated Rate |
$827.90 |
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$389.60
|
| Rate for Payer: Galaxy Health WC |
$827.90
|
| Rate for Payer: Global Benefits Group Commercial |
$584.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$649.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.76
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Networks By Design Commercial |
$633.10
|
| Rate for Payer: Prime Health Services Commercial |
$827.90
|
|
|
HC IMMUNOTYPING ELECTROPHORESIS
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
900913611
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.10 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$185.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.80
|
| Rate for Payer: Blue Distinction Transplant |
$51.00
|
| Rate for Payer: Blue Shield of California Commercial |
$54.91
|
| Rate for Payer: Blue Shield of California EPN |
$43.52
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.51
|
| Rate for Payer: Dignity Health Media |
$22.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.16
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$22.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.34
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$63.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$36.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$36.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$36.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.94
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.10
|
| Rate for Payer: United Healthcare All Other HMO |
$18.10
|
| Rate for Payer: United Healthcare HMO Rider |
$18.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.57
|
| Rate for Payer: Vantage Medical Group Senior |
$22.34
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.68 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC IMPEDANCE TESTING
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
908710301
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.11 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$82.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.81
|
| Rate for Payer: Blue Distinction Transplant |
$199.20
|
| Rate for Payer: Blue Shield of California Commercial |
$244.68
|
| Rate for Payer: Blue Shield of California EPN |
$193.89
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cigna of CA HMO |
$212.48
|
| Rate for Payer: Cigna of CA PPO |
$245.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$249.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$81.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.00
|
| Rate for Payer: United Healthcare All Other HMO |
$166.00
|
| Rate for Payer: United Healthcare HMO Rider |
$166.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
OP
|
$15,029.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.82 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,720.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,774.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,265.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,265.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$9,017.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,851.81
|
| Rate for Payer: Blue Shield of California EPN |
$5,110.40
|
| Rate for Payer: Cash Price |
$6,763.05
|
| Rate for Payer: Cash Price |
$6,763.05
|
| Rate for Payer: Cigna of CA PPO |
$11,121.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,774.65
|
| Rate for Payer: Dignity Health Media |
$12,774.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,774.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,011.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,011.60
|
| Rate for Payer: Galaxy Health WC |
$12,774.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,017.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,271.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,024.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,606.96
|
| Rate for Payer: Multiplan Commercial |
$12,023.20
|
| Rate for Payer: Networks By Design Commercial |
$9,768.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,774.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,017.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,774.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,774.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12,774.65
|
|
|
HC IMPELLA LT ART VEN TRANS
|
Facility
|
IP
|
$15,029.00
|
|
|
Service Code
|
CPT 33991
|
| Hospital Charge Code |
906811991
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,606.96 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$6,763.05
|
| Rate for Payer: Cash Price |
$6,763.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,011.60
|
| Rate for Payer: Galaxy Health WC |
$12,774.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,017.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,024.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,726.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,606.96
|
| Rate for Payer: Multiplan Commercial |
$12,023.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,774.65
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
IP
|
$21,819.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,236.56 |
| Max. Negotiated Rate |
$18,546.15 |
| Rate for Payer: Cash Price |
$9,818.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,727.60
|
| Rate for Payer: Galaxy Health WC |
$18,546.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,091.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,553.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,313.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,236.56
|
| Rate for Payer: Multiplan Commercial |
$17,455.20
|
| Rate for Payer: Networks By Design Commercial |
$14,182.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,546.15
|
|
|
HC IMPLANTED PERIONEAL PORT
|
Facility
|
OP
|
$21,819.00
|
|
|
Service Code
|
CPT 49419
|
| Hospital Charge Code |
909001457
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$403.46 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$13,091.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10,844.87
|
| Rate for Payer: Blue Shield of California EPN |
$7,058.45
|
| Rate for Payer: Cash Price |
$9,818.55
|
| Rate for Payer: Cash Price |
$9,818.55
|
| Rate for Payer: Cigna of CA PPO |
$16,146.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$18,546.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,091.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,364.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,553.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$403.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,236.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$17,455.20
|
| Rate for Payer: Networks By Design Commercial |
$14,182.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,546.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,091.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC IMPL SPINAL CANAL CATH
|
Facility
|
OP
|
$16,907.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$495.86 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,323.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,144.20
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$7,608.15
|
| Rate for Payer: Cash Price |
$7,608.15
|
| Rate for Payer: Cigna of CA PPO |
$12,511.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Dignity Health Media |
$8,323.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,155.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,236.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,323.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,323.04
|
| Rate for Payer: Galaxy Health WC |
$14,370.95
|
| Rate for Payer: Global Benefits Group Commercial |
$10,144.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,680.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,649.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$13,649.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$13,483.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$13,483.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,323.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,276.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,323.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,057.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,487.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,152.87
|
| Rate for Payer: Multiplan Commercial |
$13,525.60
|
| Rate for Payer: Multiplan WC |
$11,378.77
|
| Rate for Payer: Networks By Design Commercial |
$10,989.55
|
| Rate for Payer: Prime Health Services Commercial |
$14,370.95
|
| Rate for Payer: Prime Health Services WC |
$11,262.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,144.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,484.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,155.34
|
| Rate for Payer: Vantage Medical Group Senior |
$8,323.04
|
|
|
HC IMPL SPINAL CANAL CATH
|
Facility
|
IP
|
$16,907.00
|
|
|
Service Code
|
CPT 62350
|
| Hospital Charge Code |
900100865
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,057.68 |
| Max. Negotiated Rate |
$14,370.95 |
| Rate for Payer: Cash Price |
$7,608.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,762.80
|
| Rate for Payer: Galaxy Health WC |
$14,370.95
|
| Rate for Payer: Global Benefits Group Commercial |
$10,144.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,276.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,441.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,057.68
|
| Rate for Payer: Multiplan Commercial |
$13,525.60
|
| Rate for Payer: Networks By Design Commercial |
$10,989.55
|
| Rate for Payer: Prime Health Services Commercial |
$14,370.95
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
OP
|
$2,091.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$501.84 |
| Max. Negotiated Rate |
$4,349.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,556.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,349.74
|
| Rate for Payer: Blue Distinction Transplant |
$1,254.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,235.78
|
| Rate for Payer: Blue Shield of California EPN |
$980.68
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: Cigna of CA HMO |
$1,338.24
|
| Rate for Payer: Cigna of CA PPO |
$1,547.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Media |
$735.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$735.49
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,568.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,206.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,206.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$985.56
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,254.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC IMRT TREATMENT DELIVERY COMPLEX
|
Facility
|
IP
|
$2,091.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
909177386
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$501.84 |
| Max. Negotiated Rate |
$1,777.35 |
| Rate for Payer: Cash Price |
$940.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$836.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$836.40
|
| Rate for Payer: Galaxy Health WC |
$1,777.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,254.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,394.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$796.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$501.84
|
| Rate for Payer: Multiplan Commercial |
$1,672.80
|
| Rate for Payer: Networks By Design Commercial |
$1,359.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,777.35
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
OP
|
$1,986.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$476.64 |
| Max. Negotiated Rate |
$3,624.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,552.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,624.08
|
| Rate for Payer: Blue Distinction Transplant |
$1,191.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,173.73
|
| Rate for Payer: Blue Shield of California EPN |
$931.43
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: Cigna of CA HMO |
$1,271.04
|
| Rate for Payer: Cigna of CA PPO |
$1,469.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Dignity Health Media |
$735.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$735.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$735.49
|
| Rate for Payer: Galaxy Health WC |
$1,688.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,191.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,489.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,206.20
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,206.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,191.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,324.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$985.56
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: Networks By Design Commercial |
$1,290.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,688.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,191.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,103.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.04
|
| Rate for Payer: Vantage Medical Group Senior |
$735.49
|
|
|
HC IMRT TREATMENT DELIVERY SIMPLE
|
Facility
|
IP
|
$1,986.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
909177385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$476.64 |
| Max. Negotiated Rate |
$1,688.10 |
| Rate for Payer: Cash Price |
$893.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$794.40
|
| Rate for Payer: Galaxy Health WC |
$1,688.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,191.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,324.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$756.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$476.64
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: Networks By Design Commercial |
$1,290.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,688.10
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
IP
|
$14,962.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,590.88 |
| Max. Negotiated Rate |
$12,717.70 |
| Rate for Payer: Cash Price |
$6,732.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,984.80
|
| Rate for Payer: Galaxy Health WC |
$12,717.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,977.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,979.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,700.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,590.88
|
| Rate for Payer: Multiplan Commercial |
$11,969.60
|
| Rate for Payer: Networks By Design Commercial |
$9,725.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,717.70
|
|
|
HC IN111 ZEVALIN UP TO 5 MCI
|
Facility
|
OP
|
$14,962.00
|
|
|
Service Code
|
CPT A9542
|
| Hospital Charge Code |
909301342
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,590.88 |
| Max. Negotiated Rate |
$12,717.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,717.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,229.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,229.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,466.14
|
| Rate for Payer: Blue Distinction Transplant |
$8,977.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,842.54
|
| Rate for Payer: Blue Shield of California EPN |
$7,017.18
|
| Rate for Payer: Cash Price |
$6,732.90
|
| Rate for Payer: Cash Price |
$6,732.90
|
| Rate for Payer: Cigna of CA HMO |
$9,575.68
|
| Rate for Payer: Cigna of CA PPO |
$11,071.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,717.70
|
| Rate for Payer: Dignity Health Media |
$12,717.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,717.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,984.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,984.80
|
| Rate for Payer: Galaxy Health WC |
$12,717.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,977.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,221.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,979.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,631.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,590.88
|
| Rate for Payer: Multiplan Commercial |
$11,969.60
|
| Rate for Payer: Networks By Design Commercial |
$9,725.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,717.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,977.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,977.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,481.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,481.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,481.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,481.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,717.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,717.70
|
| Rate for Payer: Vantage Medical Group Senior |
$12,717.70
|
|
|
HC INACT POLIO ADMINISTRATION
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
908603015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC INACT POLIO ADMINISTRATION
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
908603015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.64
|
| Rate for Payer: Blue Distinction Transplant |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.19
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Media |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
IP
|
$2,511.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$602.64 |
| Max. Negotiated Rate |
$2,134.35 |
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.40
|
| Rate for Payer: Galaxy Health WC |
$2,134.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.64
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: Networks By Design Commercial |
$1,632.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,134.35
|
|
|
HC INCISE/DRAIN TEAR GLAND
|
Facility
|
OP
|
$2,511.00
|
|
|
Service Code
|
CPT 68400
|
| Hospital Charge Code |
900501642
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$69.33 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,506.60
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,129.95
|
| Rate for Payer: Cigna of CA PPO |
$1,858.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Dignity Health Media |
$1,264.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,391.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,707.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,264.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,264.97
|
| Rate for Payer: Galaxy Health WC |
$2,134.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,883.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,074.55
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,074.55
|
| 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 |
$1,264.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,264.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,593.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,695.06
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: Networks By Design Commercial |
$1,632.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,134.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,506.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,255.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,255.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,255.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,897.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,391.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,264.97
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
|
IP
|
$1,163.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.12 |
| Max. Negotiated Rate |
$988.55 |
| Rate for Payer: Cash Price |
$523.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.20
|
| Rate for Payer: Galaxy Health WC |
$988.55
|
| Rate for Payer: Global Benefits Group Commercial |
$697.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$775.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.12
|
| Rate for Payer: Multiplan Commercial |
$930.40
|
| Rate for Payer: Networks By Design Commercial |
$755.95
|
| Rate for Payer: Prime Health Services Commercial |
$988.55
|
|
|
HC INCISIONAL BX SKIN SINGLE LSN
|
Facility
|
OP
|
$1,163.00
|
|
|
Service Code
|
CPT 11106
|
| Hospital Charge Code |
900511106
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$258.19 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$697.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$523.35
|
| Rate for Payer: Cash Price |
$523.35
|
| Rate for Payer: Cigna of CA PPO |
$860.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$988.55
|
| Rate for Payer: Global Benefits Group Commercial |
$697.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$872.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,271.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,271.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$775.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$930.40
|
| Rate for Payer: Networks By Design Commercial |
$755.95
|
| Rate for Payer: Prime Health Services Commercial |
$988.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$697.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC INCISION DRAIN DEEP RECTAL ABSCESS
|
Facility
|
IP
|
$6,052.00
|
|
|
Service Code
|
CPT 45020
|
| Hospital Charge Code |
900501241
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,452.48 |
| Max. Negotiated Rate |
$5,144.20 |
| Rate for Payer: Cash Price |
$2,723.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,420.80
|
| Rate for Payer: Galaxy Health WC |
$5,144.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,631.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,036.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,305.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,452.48
|
| Rate for Payer: Multiplan Commercial |
$4,841.60
|
| Rate for Payer: Networks By Design Commercial |
$3,933.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,144.20
|
|
