|
HC CYTOPATH SMEARS PG
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$306.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.13
|
| Rate for Payer: BCBS Transplant Transplant |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$55.56
|
| Rate for Payer: Blue Shield of California EPN |
$44.03
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| 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 |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$64.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$82.18
|
| Rate for Payer: Heritage Provider Network Transplant |
$82.18
|
| Rate for Payer: IEHP Medi-Cal |
$81.18
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$81.18
|
| Rate for Payer: IEHP Medicare Advantage |
$50.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.64
|
| 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 |
$68.80
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| 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 CYTOPATH THINPREP PAP
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$168.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$168.45
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.99
|
| Rate for Payer: BCBS Transplant 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 |
$30.39
|
| Rate for Payer: Dignity Health Media |
$20.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.26
|
| 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 Transplant Other |
$129.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$33.23
|
| Rate for Payer: IEHP Medi-Cal |
$32.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$32.82
|
| Rate for Payer: IEHP Medicare Advantage |
$20.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.15
|
| 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: Redlands Yucaipa Medical Group Commercial/Senior |
$103.20
|
| 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 |
$16.41
|
| Rate for Payer: United Healthcare All Other HMO |
$16.41
|
| Rate for Payer: United Healthcare HMO Rider |
$16.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
HC CYTOPATH THINPREP PAP
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| 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 CYTOPATH THINPREP PAP RESCRN
|
Facility
IP
|
$144.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$34.56 |
| Max. Negotiated Rate |
$122.40 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
OP
|
$144.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$141.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$23.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.28
|
| Rate for Payer: BCBS Transplant Transplant |
$86.40
|
| Rate for Payer: Blue Shield of California Commercial |
$93.02
|
| Rate for Payer: Blue Shield of California EPN |
$73.73
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.56
|
| Rate for Payer: Dignity Health Media |
$23.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.04
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$37.79
|
| Rate for Payer: IEHP Medi-Cal |
$37.32
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$37.32
|
| Rate for Payer: IEHP Medicare Advantage |
$23.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.87
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.67
|
| Rate for Payer: United Healthcare All Other HMO |
$18.67
|
| Rate for Payer: United Healthcare HMO Rider |
$18.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Vantage Medical Group Senior |
$23.04
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
OP
|
$374.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$317.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$205.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$224.40
|
| 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 |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.90
|
| Rate for Payer: Dignity Health Media |
$317.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$280.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.76
|
| Rate for Payer: Multiplan Commercial |
$299.20
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| 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 |
$317.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.90
|
| Rate for Payer: Vantage Medical Group Senior |
$317.90
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
IP
|
$978.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.72 |
| Max. Negotiated Rate |
$831.30 |
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$391.20
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$372.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
IP
|
$374.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$317.90 |
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.76
|
| Rate for Payer: Multiplan Commercial |
$299.20
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
OP
|
$978.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$1,464.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,464.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$245.94
|
| Rate for Payer: BCBS Transplant Transplant |
$586.80
|
| Rate for Payer: Blue Shield of California Commercial |
$578.00
|
| Rate for Payer: Blue Shield of California EPN |
$458.68
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cash Price |
$440.10
|
| Rate for Payer: Cigna of CA HMO |
$625.92
|
| Rate for Payer: Cigna of CA PPO |
$723.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$831.30
|
| Rate for Payer: Global Benefits Group Commercial |
$586.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$733.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$652.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$782.40
|
| Rate for Payer: Networks By Design Commercial |
$635.70
|
| Rate for Payer: Prime Health Services Commercial |
$831.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$586.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$586.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$586.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC D & C 1ST TRIMESTER
|
Facility
IP
|
$7,288.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,749.12 |
| Max. Negotiated Rate |
$6,194.80 |
| Rate for Payer: Cash Price |
$3,279.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,915.20
|
| Rate for Payer: Galaxy Health WC |
$6,194.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,372.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,861.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,776.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,749.12
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: Networks By Design Commercial |
$4,737.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,194.80
|
|
|
HC D & C 1ST TRIMESTER
|
Facility
OP
|
$7,288.00
|
|
|
Service Code
|
CPT 59820
|
| Hospital Charge Code |
910400028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$752.70 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,372.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,371.26
|
| Rate for Payer: Blue Shield of California EPN |
$4,256.19
|
| Rate for Payer: Cash Price |
$3,279.60
|
| Rate for Payer: Cash Price |
$3,279.60
|
| Rate for Payer: Cigna of CA HMO |
$4,664.32
|
| Rate for Payer: Cigna of CA PPO |
$5,393.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,194.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,372.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,466.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: IEHP Medi-Cal |
$6,328.01
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,861.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$752.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,749.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: Networks By Design Commercial |
$4,737.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,194.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,372.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,372.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,372.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,644.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,644.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,644.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,644.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC D & C 2ND TRIMESTER
|
Facility
IP
|
$7,288.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
910400030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,749.12 |
| Max. Negotiated Rate |
$6,194.80 |
| Rate for Payer: Cash Price |
$3,279.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,915.20
|
| Rate for Payer: Galaxy Health WC |
$6,194.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,372.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,861.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,776.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,749.12
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: Networks By Design Commercial |
$4,737.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,194.80
|
|
|
HC D & C 2ND TRIMESTER
|
Facility
OP
|
$7,288.00
|
|
|
Service Code
|
CPT 59821
|
| Hospital Charge Code |
910400030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,372.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,371.26
|
| Rate for Payer: Blue Shield of California EPN |
$4,256.19
|
| Rate for Payer: Cash Price |
$3,279.60
|
| Rate for Payer: Cash Price |
$3,279.60
|
| Rate for Payer: Cigna of CA HMO |
$4,664.32
|
| Rate for Payer: Cigna of CA PPO |
$5,393.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,194.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,372.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,466.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: IEHP Medi-Cal |
$6,328.01
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,861.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,749.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$5,830.40
|
| Rate for Payer: Networks By Design Commercial |
$4,737.20
|
| Rate for Payer: Prime Health Services Commercial |
$6,194.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,372.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,372.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,372.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,644.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,644.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,644.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,644.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC D DIMER
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$84.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.81
|
| Rate for Payer: BCBS Transplant Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$20.03
|
| Rate for Payer: Blue Shield of California EPN |
$15.87
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Media |
$10.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$16.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$16.70
|
| Rate for Payer: IEHP Medi-Cal |
$16.49
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$16.49
|
| Rate for Payer: IEHP Medicare Advantage |
$10.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC DEB OF FX SKIN MUSCLE
|
Facility
OP
|
$12,690.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$536.18 |
| Max. Negotiated Rate |
$10,786.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,614.00
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: Cigna of CA PPO |
$9,390.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$10,786.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,614.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,517.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,045.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$10,152.00
|
| Rate for Payer: Networks By Design Commercial |
$8,248.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,786.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,614.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,614.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,345.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,345.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,345.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,345.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC DEB OF FX SKIN MUSCLE
|
Facility
IP
|
$12,690.00
|
|
|
Service Code
|
CPT 11011
|
| Hospital Charge Code |
900502138
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,045.60 |
| Max. Negotiated Rate |
$10,786.50 |
| Rate for Payer: Cash Price |
$5,710.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,076.00
|
| Rate for Payer: Galaxy Health WC |
$10,786.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,614.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,464.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,834.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,045.60
|
| Rate for Payer: Multiplan Commercial |
$10,152.00
|
| Rate for Payer: Networks By Design Commercial |
$8,248.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,786.50
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
IP
|
$12,443.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$2,986.32 |
| Max. Negotiated Rate |
$10,576.55 |
| Rate for Payer: Cash Price |
$5,599.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,977.20
|
| Rate for Payer: Galaxy Health WC |
$10,576.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,465.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,740.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,986.32
|
| Rate for Payer: Multiplan Commercial |
$9,954.40
|
| Rate for Payer: Networks By Design Commercial |
$8,087.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,576.55
|
|
|
HC DEB OF SKIN MUSCLE BONE
|
Facility
OP
|
$12,443.00
|
|
|
Service Code
|
CPT 11012
|
| Hospital Charge Code |
900501009
|
|
Hospital Revenue Code
|
490
|
| Min. Negotiated Rate |
$731.42 |
| Max. Negotiated Rate |
$10,576.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,325.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,550.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,465.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,170.49
|
| Rate for Payer: Blue Shield of California EPN |
$7,266.71
|
| Rate for Payer: Cash Price |
$5,599.35
|
| Rate for Payer: Cash Price |
$5,599.35
|
| Rate for Payer: Cigna of CA PPO |
$9,207.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,325.39
|
| Rate for Payer: Dignity Health Media |
$3,550.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,905.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,792.85
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,550.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,550.26
|
| Rate for Payer: Galaxy Health WC |
$10,576.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,465.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,332.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,822.43
|
| Rate for Payer: Heritage Provider Network Transplant |
$5,822.43
|
| Rate for Payer: IEHP Medi-Cal |
$5,751.42
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$5,751.42
|
| Rate for Payer: IEHP Medicare Advantage |
$3,550.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,299.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$731.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,550.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,986.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,473.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,757.35
|
| Rate for Payer: Multiplan Commercial |
$9,954.40
|
| Rate for Payer: Networks By Design Commercial |
$8,087.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,576.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,465.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,465.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,465.80
|
| 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 |
$5,325.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,905.29
|
| Rate for Payer: Vantage Medical Group Senior |
$3,550.26
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
OP
|
$259.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$155.40
|
| Rate for Payer: Blue Shield of California Commercial |
$190.88
|
| Rate for Payer: Blue Shield of California EPN |
$151.26
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cigna of CA HMO |
$165.76
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$194.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: IEHP Medi-Cal |
$123.80
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$123.80
|
| Rate for Payer: IEHP Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$129.50
|
| Rate for Payer: United Healthcare HMO Rider |
$129.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC DEBRIDEMENT NAIL 1-5
|
Facility
IP
|
$259.00
|
|
|
Service Code
|
CPT 11720
|
| Hospital Charge Code |
902890368
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$62.16 |
| Max. Negotiated Rate |
$220.15 |
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.16
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
OP
|
$10,187.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$384.81 |
| Max. Negotiated Rate |
$8,658.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$6,112.20
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: Cigna of CA PPO |
$7,538.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$8,658.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,112.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$7,640.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,794.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$8,149.60
|
| Rate for Payer: Networks By Design Commercial |
$6,621.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,658.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,093.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,093.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,093.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,093.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC DEBRIDEMENT SKIN MUSCLE & BONE
|
Facility
IP
|
$10,187.00
|
|
|
Service Code
|
CPT 11044
|
| Hospital Charge Code |
900501261
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,444.88 |
| Max. Negotiated Rate |
$8,658.95 |
| Rate for Payer: Cash Price |
$4,584.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,074.80
|
| Rate for Payer: Galaxy Health WC |
$8,658.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,112.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,794.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,881.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.88
|
| Rate for Payer: Multiplan Commercial |
$8,149.60
|
| Rate for Payer: Networks By Design Commercial |
$6,621.55
|
| Rate for Payer: Prime Health Services Commercial |
$8,658.95
|
|
|
HC DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
OP
|
$3,039.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.81 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,823.40
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cigna of CA PPO |
$2,248.86
|
| 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 |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,279.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,286.92
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| 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 |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,823.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,823.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,519.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,519.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,519.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,519.50
|
| 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 DEB SKIN & SUBCU TISS/MUSCLE
|
Facility
IP
|
$3,039.00
|
|
|
Service Code
|
CPT 11043
|
| Hospital Charge Code |
900501379
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$729.36 |
| Max. Negotiated Rate |
$2,583.15 |
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,027.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$729.36
|
| Rate for Payer: Multiplan Commercial |
$2,431.20
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
|
|
HC DEB SKIN SUBQ FOREIGN MATERIAL
|
Facility
OP
|
$11,671.00
|
|
|
Service Code
|
CPT 11010
|
| Hospital Charge Code |
900501008
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$427.96 |
| Max. Negotiated Rate |
$9,920.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$7,002.60
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cash Price |
$5,251.95
|
| Rate for Payer: Cigna of CA PPO |
$8,636.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$9,920.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,002.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,753.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,441.67
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,441.67
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,784.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,801.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$9,336.80
|
| Rate for Payer: Networks By Design Commercial |
$7,586.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,920.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,002.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,002.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,835.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,835.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,835.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,835.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
