|
HC RADIOPHARM THERAPY ORAL ADMIN
|
Facility
|
IP
|
$2,850.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
909301454
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$684.00 |
| Max. Negotiated Rate |
$2,422.50 |
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,140.00
|
| Rate for Payer: Galaxy Health WC |
$2,422.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,900.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,085.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.00
|
| Rate for Payer: Multiplan Commercial |
$2,280.00
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,422.50
|
|
|
HC RADIOPHARM THERAPY ORAL ADMIN
|
Facility
|
OP
|
$2,850.00
|
|
|
Service Code
|
CPT 79005
|
| Hospital Charge Code |
909301454
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$226.31 |
| Max. Negotiated Rate |
$2,422.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$347.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$668.42
|
| Rate for Payer: Blue Distinction Transplant |
$1,710.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,684.35
|
| Rate for Payer: Blue Shield of California EPN |
$1,336.65
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cash Price |
$1,282.50
|
| Rate for Payer: Cigna of CA HMO |
$1,824.00
|
| Rate for Payer: Cigna of CA PPO |
$2,109.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Media |
$310.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.84
|
| Rate for Payer: Galaxy Health WC |
$2,422.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,710.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,137.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Transplant |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,900.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.53
|
| Rate for Payer: Multiplan Commercial |
$2,280.00
|
| Rate for Payer: Networks By Design Commercial |
$1,852.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,422.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,710.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,710.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$589.62
|
| Rate for Payer: United Healthcare All Other HMO |
$589.62
|
| Rate for Payer: United Healthcare HMO Rider |
$589.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$589.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
IP
|
$5,400.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$1,296.00 |
| Max. Negotiated Rate |
$4,590.00 |
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,160.00
|
| Rate for Payer: Galaxy Health WC |
$4,590.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,240.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,601.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,057.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.00
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: Networks By Design Commercial |
$3,510.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,590.00
|
|
|
HC RADIOPHARM THERAPY Y-90 ZEVALIN
|
Facility
|
OP
|
$5,400.00
|
|
|
Service Code
|
CPT 79403
|
| Hospital Charge Code |
909301344
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$270.29 |
| Max. Negotiated Rate |
$4,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$583.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,217.32
|
| Rate for Payer: Blue Distinction Transplant |
$3,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,191.40
|
| Rate for Payer: Blue Shield of California EPN |
$2,532.60
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,430.00
|
| Rate for Payer: Cigna of CA HMO |
$3,456.00
|
| Rate for Payer: Cigna of CA PPO |
$3,996.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$466.26
|
| Rate for Payer: Dignity Health Media |
$310.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$419.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$310.84
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.84
|
| Rate for Payer: Galaxy Health WC |
$4,590.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,240.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,050.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$509.78
|
| Rate for Payer: Heritage Provider Network Transplant |
$509.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$503.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$310.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,601.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$270.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$391.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.53
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: Networks By Design Commercial |
$3,510.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,590.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$742.99
|
| Rate for Payer: United Healthcare All Other HMO |
$742.99
|
| Rate for Payer: United Healthcare HMO Rider |
$742.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$742.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$466.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.92
|
| Rate for Payer: Vantage Medical Group Senior |
$310.84
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,261.44 |
| Max. Negotiated Rate |
$4,467.60 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC RADIOPHRM AGNT OF TMR SNGL DAY
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
909301440
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$294.31 |
| Max. Negotiated Rate |
$4,467.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,810.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,131.52
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,106.30
|
| Rate for Payer: Blue Shield of California EPN |
$2,465.06
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,909.61
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,874.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,261.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,235.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$4,204.80
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,260.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,260.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,260.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,260.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA MCAL
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900400016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.23 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$169.20
|
| 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 |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Media |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| 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 |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RANGE OF MOTION EXTR/TRUNK EA MCAL
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
900400016
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$169.20
|
| 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 |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Media |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| 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 |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
901300033
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900400018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC RANGE OF MOTION MEAS HAND MCAL
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95852
|
| Hospital Charge Code |
900400018
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$30.97 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$169.20
|
| 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 |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Media |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| 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 |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RANGE OF MOTION MEAS LIMB/TRUNK MCAL
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
901300031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC RANGE OF MOTION MEAS LIMB/TRUNK MCAL
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
901300031
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.23 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$169.20
|
| 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 |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Media |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| 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 |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RANGE OF MOTION MEAS LIMB TRUNK OT
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$28.23 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$50.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$155.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$155.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$169.20
|
| 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 |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.70
|
| Rate for Payer: Dignity Health Media |
$239.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$211.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| 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 |
$239.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.70
|
| Rate for Payer: Vantage Medical Group Senior |
$239.70
|
|
|
HC RANGE OF MOTION MEAS LIMB TRUNK OT
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 95851
|
| Hospital Charge Code |
905104406
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$67.68 |
| Max. Negotiated Rate |
$239.70 |
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.68
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$162.48 |
| Max. Negotiated Rate |
$575.45 |
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.80
|
| Rate for Payer: Galaxy Health WC |
$575.45
|
| Rate for Payer: Global Benefits Group Commercial |
$406.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$451.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.48
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: Networks By Design Commercial |
$440.05
|
| Rate for Payer: Prime Health Services Commercial |
$575.45
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$162.48 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$383.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.36
|
| Rate for Payer: Blue Distinction Transplant |
$406.20
|
| Rate for Payer: Blue Shield of California Commercial |
$498.95
|
| Rate for Payer: Blue Shield of California EPN |
$395.37
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cash Price |
$304.65
|
| Rate for Payer: Cigna of CA HMO |
$433.28
|
| Rate for Payer: Cigna of CA PPO |
$500.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$293.22
|
| Rate for Payer: Dignity Health Media |
$195.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$215.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.90
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.48
|
| Rate for Payer: Galaxy Health WC |
$575.45
|
| Rate for Payer: Global Benefits Group Commercial |
$406.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$507.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$316.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$451.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$246.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.94
|
| Rate for Payer: Multiplan Commercial |
$541.60
|
| Rate for Payer: Networks By Design Commercial |
$440.05
|
| Rate for Payer: Prime Health Services Commercial |
$575.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$406.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$406.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$293.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$215.03
|
| Rate for Payer: Vantage Medical Group Senior |
$195.48
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
IP
|
$1,118.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$268.32 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
OP
|
$1,118.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.04 |
| Max. Negotiated Rate |
$950.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$307.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$614.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$614.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$332.30
|
| Rate for Payer: Blue Distinction Transplant |
$670.80
|
| Rate for Payer: Blue Shield of California Commercial |
$660.74
|
| Rate for Payer: Blue Shield of California EPN |
$524.34
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cash Price |
$503.10
|
| Rate for Payer: Cigna of CA HMO |
$715.52
|
| Rate for Payer: Cigna of CA PPO |
$827.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$950.30
|
| Rate for Payer: Dignity Health Media |
$950.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$447.20
|
| Rate for Payer: Galaxy Health WC |
$950.30
|
| Rate for Payer: Global Benefits Group Commercial |
$670.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$838.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$745.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Networks By Design Commercial |
$726.70
|
| Rate for Payer: Prime Health Services Commercial |
$950.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$670.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$670.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$559.00
|
| Rate for Payer: United Healthcare All Other HMO |
$559.00
|
| Rate for Payer: United Healthcare HMO Rider |
$559.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$559.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$950.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.30
|
| Rate for Payer: Vantage Medical Group Senior |
$950.30
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.96 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.84 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$477.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.33
|
| Rate for Payer: Blue Distinction Transplant |
$842.40
|
| Rate for Payer: Blue Shield of California Commercial |
$829.76
|
| Rate for Payer: Blue Shield of California EPN |
$658.48
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna of CA HMO |
$898.56
|
| Rate for Payer: Cigna of CA PPO |
$1,038.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,053.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$842.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.43
|
| Rate for Payer: United Healthcare All Other HMO |
$466.43
|
| Rate for Payer: United Healthcare HMO Rider |
$466.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.96 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$429.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.29
|
| Rate for Payer: Blue Distinction Transplant |
$842.40
|
| Rate for Payer: Blue Shield of California Commercial |
$829.76
|
| Rate for Payer: Blue Shield of California EPN |
$658.48
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna of CA HMO |
$898.56
|
| Rate for Payer: Cigna of CA PPO |
$1,038.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,053.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$842.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.08 |
| Max. Negotiated Rate |
$991.95 |
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$466.80
|
| Rate for Payer: Galaxy Health WC |
$991.95
|
| Rate for Payer: Global Benefits Group Commercial |
$700.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$778.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.08
|
| Rate for Payer: Multiplan Commercial |
$933.60
|
| Rate for Payer: Networks By Design Commercial |
$758.55
|
| Rate for Payer: Prime Health Services Commercial |
$991.95
|
|
