|
HC JEJUNOSTOMY PERC
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 74355
|
| Hospital Charge Code |
909001868
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$195.81 |
| Max. Negotiated Rate |
$1,061.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$662.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,061.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$686.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$686.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.14
|
| Rate for Payer: Blue Distinction Transplant |
$749.40
|
| Rate for Payer: Blue Shield of California Commercial |
$738.16
|
| Rate for Payer: Blue Shield of California EPN |
$585.78
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Cash Price |
$562.05
|
| Rate for Payer: Cigna of CA HMO |
$799.36
|
| Rate for Payer: Cigna of CA PPO |
$924.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,061.65
|
| Rate for Payer: Dignity Health Media |
$1,061.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,061.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$499.60
|
| Rate for Payer: Galaxy Health WC |
$1,061.65
|
| Rate for Payer: Global Benefits Group Commercial |
$749.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$936.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.76
|
| Rate for Payer: Multiplan Commercial |
$999.20
|
| Rate for Payer: Networks By Design Commercial |
$811.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,061.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$749.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$749.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$624.50
|
| Rate for Payer: United Healthcare All Other HMO |
$624.50
|
| Rate for Payer: United Healthcare HMO Rider |
$624.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$624.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,061.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,061.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,061.65
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$303.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA PPO |
$373.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Media |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$378.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| 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 |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$534.65 |
| Rate for Payer: Cash Price |
$283.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$251.60
|
| Rate for Payer: Galaxy Health WC |
$534.65
|
| Rate for Payer: Global Benefits Group Commercial |
$377.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$419.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.96
|
| Rate for Payer: Multiplan Commercial |
$503.20
|
| Rate for Payer: Networks By Design Commercial |
$408.85
|
| Rate for Payer: Prime Health Services Commercial |
$534.65
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$7,282.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$303.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA PPO |
$373.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Media |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$378.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$328.25
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| 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 |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$629.00
|
|
|
Service Code
|
CPT 44015
|
| Hospital Charge Code |
906744015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.96 |
| Max. Negotiated Rate |
$534.65 |
| Rate for Payer: Cash Price |
$283.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$251.60
|
| Rate for Payer: Galaxy Health WC |
$534.65
|
| Rate for Payer: Global Benefits Group Commercial |
$377.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$419.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.96
|
| Rate for Payer: Multiplan Commercial |
$503.20
|
| Rate for Payer: Networks By Design Commercial |
$408.85
|
| Rate for Payer: Prime Health Services Commercial |
$534.65
|
|
|
HC JO-1 AUTO AB
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913526
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$138.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.94
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$29.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
OP
|
$1,460.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$72.14 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$876.00
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: Cigna of CA PPO |
$1,080.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,241.00
|
| Rate for Payer: Global Benefits Group Commercial |
$876.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,095.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$599.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,168.00
|
| Rate for Payer: Networks By Design Commercial |
$949.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,241.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$876.00
|
| 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 |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC JOINT ASPIR/INJ-INTER JOINT
|
Facility
|
IP
|
$1,460.00
|
|
|
Service Code
|
CPT 20605
|
| Hospital Charge Code |
909000110
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$350.40 |
| Max. Negotiated Rate |
$1,241.00 |
| Rate for Payer: Cash Price |
$657.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.00
|
| Rate for Payer: Galaxy Health WC |
$1,241.00
|
| Rate for Payer: Global Benefits Group Commercial |
$876.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$973.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$556.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.40
|
| Rate for Payer: Multiplan Commercial |
$1,168.00
|
| Rate for Payer: Networks By Design Commercial |
$949.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,241.00
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
OP
|
$1,827.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$146.32 |
| Max. Negotiated Rate |
$1,552.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$533.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,088.53
|
| Rate for Payer: Blue Distinction Transplant |
$1,096.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,079.76
|
| Rate for Payer: Blue Shield of California EPN |
$856.86
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: Cigna of CA HMO |
$1,169.28
|
| Rate for Payer: Cigna of CA PPO |
$1,351.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,370.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,218.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,461.60
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,096.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,096.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.89
|
| Rate for Payer: United Healthcare All Other HMO |
$409.89
|
| Rate for Payer: United Healthcare HMO Rider |
$409.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC KIDNEY FUNCTION GFR
|
Facility
|
IP
|
$1,827.00
|
|
|
Service Code
|
CPT 78725
|
| Hospital Charge Code |
909301424
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$438.48 |
| Max. Negotiated Rate |
$1,552.95 |
| Rate for Payer: Cash Price |
$822.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.80
|
| Rate for Payer: Galaxy Health WC |
$1,552.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,096.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,218.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$696.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.48
|
| Rate for Payer: Multiplan Commercial |
$1,461.60
|
| Rate for Payer: Networks By Design Commercial |
$1,187.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,552.95
|
|
|
HC KIDNEY SCAN
|
Facility
|
OP
|
$2,854.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$227.68 |
| Max. Negotiated Rate |
$2,425.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,198.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,700.41
|
| Rate for Payer: Blue Distinction Transplant |
$1,712.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,686.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,338.53
|
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: Cigna of CA HMO |
$1,826.56
|
| Rate for Payer: Cigna of CA PPO |
$2,111.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$2,425.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,712.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,140.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,903.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$2,283.20
|
| Rate for Payer: Networks By Design Commercial |
$1,855.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,712.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,712.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC KIDNEY SCAN
|
Facility
|
IP
|
$2,854.00
|
|
|
Service Code
|
CPT 78701
|
| Hospital Charge Code |
909301420
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$684.96 |
| Max. Negotiated Rate |
$2,425.90 |
| Rate for Payer: Cash Price |
$1,284.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,141.60
|
| Rate for Payer: Galaxy Health WC |
$2,425.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,712.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,903.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,087.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.96
|
| Rate for Payer: Multiplan Commercial |
$2,283.20
|
| Rate for Payer: Networks By Design Commercial |
$1,855.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,425.90
|
|
|
HC KNEE 1-2 VIEWS
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$620.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$135.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.24
|
| Rate for Payer: Blue Distinction Transplant |
$438.00
|
| Rate for Payer: Blue Shield of California Commercial |
$431.43
|
| Rate for Payer: Blue Shield of California EPN |
$342.37
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: Cigna of CA HMO |
$467.20
|
| Rate for Payer: Cigna of CA PPO |
$540.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$620.50
|
| Rate for Payer: Global Benefits Group Commercial |
$438.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$547.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: Networks By Design Commercial |
$474.50
|
| Rate for Payer: Prime Health Services Commercial |
$620.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$438.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$438.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC KNEE 1-2 VIEWS
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.20 |
| Max. Negotiated Rate |
$620.50 |
| Rate for Payer: Cash Price |
$328.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$292.00
|
| Rate for Payer: Galaxy Health WC |
$620.50
|
| Rate for Payer: Global Benefits Group Commercial |
$438.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$278.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: Networks By Design Commercial |
$474.50
|
| Rate for Payer: Prime Health Services Commercial |
$620.50
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
IP
|
$839.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$201.36 |
| Max. Negotiated Rate |
$713.15 |
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$335.60
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$319.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.36
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
|
|
HC KNEE 3 VIEWS
|
Facility
|
OP
|
$839.00
|
|
|
Service Code
|
CPT 73562
|
| Hospital Charge Code |
909001675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$44.42 |
| Max. Negotiated Rate |
$713.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$169.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.83
|
| Rate for Payer: Blue Distinction Transplant |
$503.40
|
| Rate for Payer: Blue Shield of California Commercial |
$495.85
|
| Rate for Payer: Blue Shield of California EPN |
$393.49
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cash Price |
$377.55
|
| Rate for Payer: Cigna of CA HMO |
$536.96
|
| Rate for Payer: Cigna of CA PPO |
$620.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$713.15
|
| Rate for Payer: Global Benefits Group Commercial |
$503.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$629.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$559.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$671.20
|
| Rate for Payer: Networks By Design Commercial |
$545.35
|
| Rate for Payer: Prime Health Services Commercial |
$713.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$503.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$503.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$193.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.28
|
| Rate for Payer: Blue Distinction Transplant |
$617.40
|
| Rate for Payer: Blue Shield of California Commercial |
$608.14
|
| Rate for Payer: Blue Shield of California EPN |
$482.60
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cigna of CA HMO |
$658.56
|
| Rate for Payer: Cigna of CA PPO |
$761.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$771.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$686.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$823.20
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$617.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$617.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC KNEE COMPLETE 4 VIEWS
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
909001622
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.96 |
| Max. Negotiated Rate |
$874.65 |
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.60
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$686.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$392.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.96
|
| Rate for Payer: Multiplan Commercial |
$823.20
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
|
|
HC KNEE STANDING
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$154.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.81
|
| Rate for Payer: Blue Distinction Transplant |
$492.60
|
| Rate for Payer: Blue Shield of California Commercial |
$485.21
|
| Rate for Payer: Blue Shield of California EPN |
$385.05
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: Cigna of CA HMO |
$525.44
|
| Rate for Payer: Cigna of CA PPO |
$607.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$615.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$492.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC KNEE STANDING
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
909001624
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$197.04 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
|
|
HC LAB REF LIPID PANEL, CARDIAC
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
900912578
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$122.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$111.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.17
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.26
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.08
|
| Rate for Payer: Dignity Health Media |
$13.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.39
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.96
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.94
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.84
|
| Rate for Payer: United Healthcare All Other HMO |
$10.84
|
| Rate for Payer: United Healthcare HMO Rider |
$10.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.39
|
|
|
HC LACTATE (CSF/POC)
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 83605
|
| Hospital Charge Code |
900910245
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$97.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$88.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.42
|
| Rate for Payer: Blue Distinction 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 |
$17.36
|
| Rate for Payer: Dignity Health Media |
$11.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.62
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.57
|
| 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) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.97
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.50
|
| 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: 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 |
$9.37
|
| Rate for Payer: United Healthcare All Other HMO |
$9.37
|
| Rate for Payer: United Healthcare HMO Rider |
$9.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.73
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC LACTATE DEHYDROGENASE
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900910229
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$54.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.91
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.92
|
| Rate for Payer: Blue Shield of California EPN |
$10.24
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Media |
$6.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC LACTATE DEHYDROGENASE BODY FL
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
900912243
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$54.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.91
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Media |
$6.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.15
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.90
|
| Rate for Payer: United Healthcare All Other HMO |
$4.90
|
| Rate for Payer: United Healthcare HMO Rider |
$4.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.64
|
| Rate for Payer: Vantage Medical Group Senior |
$6.04
|
|
|
HC LACTOSE TOLERANCE
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910313
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.42 |
| Max. Negotiated Rate |
$117.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.44
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$31.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.09
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Media |
$12.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.11
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
