|
HC LAMELLAR BODY COUNT AMNIOTIC
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 83664
|
| Hospital Charge Code |
900912027
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$157.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$157.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.06
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$47.16
|
| Rate for Payer: Blue Shield of California EPN |
$37.38
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.98
|
| Rate for Payer: Dignity Health Media |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$19.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$19.32
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$31.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$31.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.89
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.65
|
| Rate for Payer: United Healthcare All Other HMO |
$15.65
|
| Rate for Payer: United Healthcare HMO Rider |
$15.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$19.32
|
|
|
HC LANGUAGE EVALUATION
|
Facility
|
IP
|
$1,002.00
|
|
| Hospital Charge Code |
905601211
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$240.48 |
| Max. Negotiated Rate |
$851.70 |
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.48
|
| Rate for Payer: Multiplan Commercial |
$801.60
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
|
|
HC LANGUAGE EVALUATION
|
Facility
|
OP
|
$1,002.00
|
|
| Hospital Charge Code |
905601211
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$851.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$657.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$851.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$551.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$551.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$601.20
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cash Price |
$450.90
|
| Rate for Payer: Cigna of CA HMO |
$641.28
|
| Rate for Payer: Cigna of CA PPO |
$741.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$851.70
|
| Rate for Payer: Dignity Health Media |
$851.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$851.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$400.80
|
| Rate for Payer: Galaxy Health WC |
$851.70
|
| Rate for Payer: Global Benefits Group Commercial |
$601.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$751.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.48
|
| Rate for Payer: Multiplan Commercial |
$801.60
|
| Rate for Payer: Networks By Design Commercial |
$651.30
|
| Rate for Payer: Prime Health Services Commercial |
$851.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$601.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$851.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$851.70
|
| Rate for Payer: Vantage Medical Group Senior |
$851.70
|
|
|
HC LARYNGOSCOPY DIRECT
|
Facility
|
OP
|
$6,392.00
|
|
|
Service Code
|
CPT 31515
|
| Hospital Charge Code |
900501121
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.68 |
| Max. Negotiated Rate |
$5,433.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,835.20
|
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: Cigna of CA PPO |
$4,730.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.27
|
| Rate for Payer: Dignity Health Media |
$510.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$510.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$510.18
|
| Rate for Payer: Galaxy Health WC |
$5,433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,835.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,794.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$836.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$836.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,263.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,534.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$642.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.64
|
| Rate for Payer: Multiplan Commercial |
$5,113.60
|
| Rate for Payer: Networks By Design Commercial |
$4,154.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,433.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,835.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,196.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,196.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Vantage Medical Group Senior |
$510.18
|
|
|
HC LARYNGOSCOPY DIRECT
|
Facility
|
IP
|
$6,392.00
|
|
|
Service Code
|
CPT 31515
|
| Hospital Charge Code |
900501121
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,534.08 |
| Max. Negotiated Rate |
$5,433.20 |
| Rate for Payer: Cash Price |
$2,876.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,556.80
|
| Rate for Payer: Galaxy Health WC |
$5,433.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,835.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,263.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,435.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,534.08
|
| Rate for Payer: Multiplan Commercial |
$5,113.60
|
| Rate for Payer: Networks By Design Commercial |
$4,154.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,433.20
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$146.43 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$393.60
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna of CA PPO |
$485.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Media |
$247.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$557.60
|
| Rate for Payer: Global Benefits Group Commercial |
$393.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$492.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$405.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$437.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: Networks By Design Commercial |
$426.40
|
| Rate for Payer: Prime Health Services Commercial |
$557.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$393.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.00
|
| Rate for Payer: United Healthcare All Other HMO |
$328.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC LARYNGOSCOPY FLEX FIBEROPTIC
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 31575
|
| Hospital Charge Code |
900501260
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.44 |
| Max. Negotiated Rate |
$557.60 |
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.40
|
| Rate for Payer: Galaxy Health WC |
$557.60
|
| Rate for Payer: Global Benefits Group Commercial |
$393.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$437.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.44
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: Networks By Design Commercial |
$426.40
|
| Rate for Payer: Prime Health Services Commercial |
$557.60
|
|
|
HC LARYNGOSCOPY INDIRECT
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.04 |
| Max. Negotiated Rate |
$485.35 |
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.40
|
| Rate for Payer: Galaxy Health WC |
$485.35
|
| Rate for Payer: Global Benefits Group Commercial |
$342.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.04
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: Networks By Design Commercial |
$371.15
|
| Rate for Payer: Prime Health Services Commercial |
$485.35
|
|
|
HC LARYNGOSCOPY INDIRECT
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 31505
|
| Hospital Charge Code |
900501120
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$247.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$342.60
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cash Price |
$256.95
|
| Rate for Payer: Cigna of CA PPO |
$422.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$371.24
|
| Rate for Payer: Dignity Health Media |
$247.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$247.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.49
|
| Rate for Payer: Galaxy Health WC |
$485.35
|
| Rate for Payer: Global Benefits Group Commercial |
$342.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$428.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$405.88
|
| Rate for Payer: Heritage Provider Network Transplant |
$405.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$247.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$380.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$331.64
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: Networks By Design Commercial |
$371.15
|
| Rate for Payer: Prime Health Services Commercial |
$485.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$342.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$285.50
|
| Rate for Payer: United Healthcare All Other HMO |
$285.50
|
| Rate for Payer: United Healthcare HMO Rider |
$285.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$371.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.24
|
| Rate for Payer: Vantage Medical Group Senior |
$247.49
|
|
|
HC LARYNGOSCOPY W/RMVL F.B.
|
Facility
|
IP
|
$2,626.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
900501549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$630.24 |
| Max. Negotiated Rate |
$2,232.10 |
| Rate for Payer: Cash Price |
$1,181.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,050.40
|
| Rate for Payer: Galaxy Health WC |
$2,232.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,575.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,751.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,000.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.24
|
| Rate for Payer: Multiplan Commercial |
$2,100.80
|
| Rate for Payer: Networks By Design Commercial |
$1,706.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,232.10
|
|
|
HC LARYNGOSCOPY W/RMVL F.B.
|
Facility
|
OP
|
$2,626.00
|
|
|
Service Code
|
CPT 31577
|
| Hospital Charge Code |
900501549
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,575.60
|
| Rate for Payer: Cash Price |
$1,181.70
|
| Rate for Payer: Cash Price |
$1,181.70
|
| Rate for Payer: Cash Price |
$1,181.70
|
| Rate for Payer: Cigna of CA PPO |
$1,943.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.27
|
| Rate for Payer: Dignity Health Media |
$510.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$510.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$510.18
|
| Rate for Payer: Galaxy Health WC |
$2,232.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,575.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,969.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$836.70
|
| Rate for Payer: Heritage Provider Network Transplant |
$836.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,751.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$642.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$683.64
|
| Rate for Payer: Multiplan Commercial |
$2,100.80
|
| Rate for Payer: Networks By Design Commercial |
$1,706.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,232.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,575.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,313.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,313.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,313.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,313.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.20
|
| Rate for Payer: Vantage Medical Group Senior |
$510.18
|
|
|
HC LARYNGOSCOPY W/TUMOR EXC W/SCO
|
Facility
|
IP
|
$12,686.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,044.64 |
| Max. Negotiated Rate |
$10,783.10 |
| Rate for Payer: Cash Price |
$5,708.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,074.40
|
| Rate for Payer: Galaxy Health WC |
$10,783.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,611.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,461.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,833.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,044.64
|
| Rate for Payer: Multiplan Commercial |
$10,148.80
|
| Rate for Payer: Networks By Design Commercial |
$8,245.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,783.10
|
|
|
HC LARYNGOSCOPY W/TUMOR EXC W/SCO
|
Facility
|
OP
|
$12,686.00
|
|
|
Service Code
|
CPT 31541
|
| Hospital Charge Code |
900501640
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$509.31 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,611.60
|
| Rate for Payer: Cash Price |
$5,708.70
|
| Rate for Payer: Cash Price |
$5,708.70
|
| Rate for Payer: Cash Price |
$5,708.70
|
| Rate for Payer: Cigna of CA PPO |
$9,387.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Media |
$4,678.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$10,783.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,611.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,514.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,673.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,673.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,461.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,044.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$10,148.80
|
| Rate for Payer: Networks By Design Commercial |
$8,245.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,783.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,611.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,343.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,343.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,343.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,343.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC LASER TREATMENT
|
Facility
|
IP
|
$8,379.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$2,010.96 |
| Max. Negotiated Rate |
$7,122.15 |
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,351.60
|
| Rate for Payer: Galaxy Health WC |
$7,122.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,027.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,192.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.96
|
| Rate for Payer: Multiplan Commercial |
$6,703.20
|
| Rate for Payer: Networks By Design Commercial |
$5,446.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,122.15
|
|
|
HC LASER TREATMENT
|
Facility
|
OP
|
$8,379.00
|
|
|
Service Code
|
CPT 31641
|
| Hospital Charge Code |
900803400
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$293.00 |
| Max. Negotiated Rate |
$7,673.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,678.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,027.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Cash Price |
$3,770.55
|
| Rate for Payer: Cigna of CA HMO |
$5,362.56
|
| Rate for Payer: Cigna of CA PPO |
$6,200.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Dignity Health Media |
$4,678.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,146.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,316.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,678.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,678.93
|
| Rate for Payer: Galaxy Health WC |
$7,122.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,027.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,284.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,673.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$7,673.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7,579.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,678.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,588.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,678.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,010.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,895.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,269.77
|
| Rate for Payer: Multiplan Commercial |
$6,703.20
|
| Rate for Payer: Networks By Design Commercial |
$5,446.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,122.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,027.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,027.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,018.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,146.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4,678.93
|
|
|
HC LASIX RENOGRAM
|
Facility
|
IP
|
$4,539.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,089.36 |
| Max. Negotiated Rate |
$3,858.15 |
| Rate for Payer: Cash Price |
$2,042.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,815.60
|
| Rate for Payer: Galaxy Health WC |
$3,858.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,723.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,027.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,729.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.36
|
| Rate for Payer: Multiplan Commercial |
$3,631.20
|
| Rate for Payer: Networks By Design Commercial |
$2,950.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,858.15
|
|
|
HC LASIX RENOGRAM
|
Facility
|
OP
|
$4,539.00
|
|
|
Service Code
|
CPT 78709
|
| Hospital Charge Code |
909301423
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$347.00 |
| Max. Negotiated Rate |
$3,858.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,890.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,704.34
|
| Rate for Payer: Blue Distinction Transplant |
$2,723.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,682.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,128.79
|
| Rate for Payer: Cash Price |
$2,042.55
|
| Rate for Payer: Cash Price |
$2,042.55
|
| Rate for Payer: Cigna of CA HMO |
$2,904.96
|
| Rate for Payer: Cigna of CA PPO |
$3,358.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$3,858.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,723.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,404.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,027.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,089.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$3,631.20
|
| Rate for Payer: Networks By Design Commercial |
$2,950.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,858.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,723.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,723.40
|
| 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 |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
IP
|
$12,570.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,016.80 |
| Max. Negotiated Rate |
$10,684.50 |
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,028.00
|
| Rate for Payer: Galaxy Health WC |
$10,684.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,542.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,789.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,016.80
|
| Rate for Payer: Multiplan Commercial |
$10,056.00
|
| Rate for Payer: Networks By Design Commercial |
$8,170.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,684.50
|
|
|
HC LATE CLOSURE SURGICAL WOUND
|
Facility
|
OP
|
$12,570.00
|
|
|
Service Code
|
CPT 13160
|
| Hospital Charge Code |
900501537
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$10,684.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,542.00
|
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: Cash Price |
$5,656.50
|
| Rate for Payer: Cigna of CA PPO |
$9,301.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$10,684.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,542.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,427.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,384.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,041.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,016.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$10,056.00
|
| Rate for Payer: Networks By Design Commercial |
$8,170.50
|
| Rate for Payer: Prime Health Services Commercial |
$10,684.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,542.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,285.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,285.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,285.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
OP
|
$2,903.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$215.04 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,741.80
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: Cigna of CA PPO |
$2,148.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,467.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,741.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,177.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$2,322.40
|
| Rate for Payer: Networks By Design Commercial |
$1,886.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,467.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,741.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,451.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,451.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,451.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,451.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WND 12.6-20.0 CM
|
Facility
|
IP
|
$2,903.00
|
|
|
Service Code
|
CPT 12035
|
| Hospital Charge Code |
900501032
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$696.72 |
| Max. Negotiated Rate |
$2,467.55 |
| Rate for Payer: Cash Price |
$1,306.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,161.20
|
| Rate for Payer: Galaxy Health WC |
$2,467.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,741.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,936.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,106.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$696.72
|
| Rate for Payer: Multiplan Commercial |
$2,322.40
|
| Rate for Payer: Networks By Design Commercial |
$1,886.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,467.55
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
IP
|
$3,192.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$766.08 |
| Max. Negotiated Rate |
$2,713.20 |
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,276.80
|
| Rate for Payer: Galaxy Health WC |
$2,713.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,216.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.08
|
| Rate for Payer: Multiplan Commercial |
$2,553.60
|
| Rate for Payer: Networks By Design Commercial |
$2,074.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,713.20
|
|
|
HC LAY CLOS OF WND 20.1-30.0 CM
|
Facility
|
OP
|
$3,192.00
|
|
|
Service Code
|
CPT 12036
|
| Hospital Charge Code |
900501244
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$752.15 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,915.20
|
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Cash Price |
$1,436.40
|
| Rate for Payer: Cigna of CA PPO |
$2,362.08
|
| 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 |
$2,713.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,915.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,394.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,129.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$752.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$766.08
|
| 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 |
$2,553.60
|
| Rate for Payer: Networks By Design Commercial |
$2,074.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,713.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,915.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,596.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,596.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,596.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,596.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
OP
|
$1,746.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.02 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,047.60
|
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: Cigna of CA PPO |
$1,292.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,484.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,309.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,396.80
|
| Rate for Payer: Networks By Design Commercial |
$1,134.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,047.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$873.00
|
| Rate for Payer: United Healthcare All Other HMO |
$873.00
|
| Rate for Payer: United Healthcare HMO Rider |
$873.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$873.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WND 2.6-7.5CM
|
Facility
|
IP
|
$1,746.00
|
|
|
Service Code
|
CPT 12032
|
| Hospital Charge Code |
900501030
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$419.04 |
| Max. Negotiated Rate |
$1,484.10 |
| Rate for Payer: Cash Price |
$785.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.40
|
| Rate for Payer: Galaxy Health WC |
$1,484.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,047.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,164.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.04
|
| Rate for Payer: Multiplan Commercial |
$1,396.80
|
| Rate for Payer: Networks By Design Commercial |
$1,134.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.10
|
|
