|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$7,597.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$55.18 |
| Max. Negotiated Rate |
$14,375.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,062.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,457.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,178.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,178.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,558.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,851.81
|
| Rate for Payer: Blue Shield of California EPN |
$5,110.40
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cash Price |
$3,418.65
|
| Rate for Payer: Cigna of CA PPO |
$5,621.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,457.45
|
| Rate for Payer: Dignity Health Media |
$6,457.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,457.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,038.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,038.80
|
| Rate for Payer: Galaxy Health WC |
$6,457.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,558.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,697.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,067.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,823.28
|
| Rate for Payer: Multiplan Commercial |
$6,077.60
|
| Rate for Payer: Networks By Design Commercial |
$4,938.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,457.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,558.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,558.20
|
| 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 |
$6,457.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,457.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,457.45
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
IP
|
$13,307.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,193.68 |
| Max. Negotiated Rate |
$11,310.95 |
| Rate for Payer: Blue Shield of California Commercial |
$9,474.58
|
| Rate for Payer: Blue Shield of California EPN |
$6,813.18
|
| Rate for Payer: Cash Price |
$5,988.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,322.80
|
| Rate for Payer: Galaxy Health WC |
$11,310.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,984.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,875.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,069.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.68
|
| Rate for Payer: Multiplan Commercial |
$10,645.60
|
| Rate for Payer: Networks By Design Commercial |
$8,649.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,310.95
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
OP
|
$13,307.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$881.39 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,984.20
|
| Rate for Payer: Cash Price |
$5,988.15
|
| Rate for Payer: Cash Price |
$5,988.15
|
| Rate for Payer: Cash Price |
$5,988.15
|
| Rate for Payer: Cigna of CA PPO |
$9,847.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$11,310.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,984.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,980.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,659.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$14,659.19
|
| 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 |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,875.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$881.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,193.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,262.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$10,645.60
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$8,649.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,310.95
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,984.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,653.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,653.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,653.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,653.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
OP
|
$5,861.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$936.00 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,516.60
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: Cigna of CA PPO |
$4,337.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$4,981.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,516.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,395.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,775.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,775.07
|
| 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 |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$4,688.80
|
| Rate for Payer: Networks By Design Commercial |
$3,809.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,981.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,516.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,930.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,930.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,930.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,930.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
IP
|
$5,861.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,406.64 |
| Max. Negotiated Rate |
$4,981.85 |
| Rate for Payer: Cash Price |
$2,637.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,344.40
|
| Rate for Payer: Galaxy Health WC |
$4,981.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,516.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,909.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,233.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,406.64
|
| Rate for Payer: Multiplan Commercial |
$4,688.80
|
| Rate for Payer: Networks By Design Commercial |
$3,809.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,981.85
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
OP
|
$5,249.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$713.03 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,149.40
|
| Rate for Payer: Cash Price |
$2,362.05
|
| Rate for Payer: Cash Price |
$2,362.05
|
| Rate for Payer: Cash Price |
$2,362.05
|
| Rate for Payer: Cigna of CA PPO |
$3,884.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$4,461.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,149.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,936.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,124.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,124.92
|
| 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 |
$1,905.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,501.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$713.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,400.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$4,199.20
|
| Rate for Payer: Networks By Design Commercial |
$3,411.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,461.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,624.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,624.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,624.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,624.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
IP
|
$5,249.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,259.76 |
| Max. Negotiated Rate |
$4,461.65 |
| Rate for Payer: Cash Price |
$2,362.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,099.60
|
| Rate for Payer: Galaxy Health WC |
$4,461.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,149.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,501.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,999.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,259.76
|
| Rate for Payer: Multiplan Commercial |
$4,199.20
|
| Rate for Payer: Networks By Design Commercial |
$3,411.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,461.65
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.94 |
| 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 |
$559.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$410.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$373.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$549.60
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna of CA PPO |
$677.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$559.78
|
| Rate for Payer: Dignity Health Media |
$373.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$410.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.81
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$373.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$373.19
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$687.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$612.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$612.03
|
| 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 |
$373.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$610.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$470.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$500.07
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$549.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$458.00
|
| Rate for Payer: United Healthcare All Other HMO |
$458.00
|
| Rate for Payer: United Healthcare HMO Rider |
$458.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$559.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$410.51
|
| Rate for Payer: Vantage Medical Group Senior |
$373.19
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.84 |
| Max. Negotiated Rate |
$778.60 |
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.40
|
| Rate for Payer: Galaxy Health WC |
$778.60
|
| Rate for Payer: Global Benefits Group Commercial |
$549.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$610.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.84
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Networks By Design Commercial |
$595.40
|
| Rate for Payer: Prime Health Services Commercial |
$778.60
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.08 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$700.20
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cigna of CA PPO |
$863.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$991.95
|
| Rate for Payer: Global Benefits Group Commercial |
$700.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$875.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| 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 |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$778.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$700.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$583.50
|
| Rate for Payer: United Healthcare All Other HMO |
$583.50
|
| Rate for Payer: United Healthcare HMO Rider |
$583.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$583.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
IP
|
$1,167.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| 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
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
OP
|
$5,008.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.71 |
| 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 |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,004.80
|
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: Cigna of CA PPO |
$3,705.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$4,256.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,004.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,756.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| 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 |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,340.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,201.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$4,006.40
|
| Rate for Payer: Networks By Design Commercial |
$3,255.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,256.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,004.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,504.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,504.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,504.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
IP
|
$5,008.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,201.92 |
| Max. Negotiated Rate |
$4,256.80 |
| Rate for Payer: Cash Price |
$2,253.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,003.20
|
| Rate for Payer: Galaxy Health WC |
$4,256.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,004.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,340.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,908.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,201.92
|
| Rate for Payer: Multiplan Commercial |
$4,006.40
|
| Rate for Payer: Networks By Design Commercial |
$3,255.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,256.80
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
IP
|
$1,555.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$373.20 |
| Max. Negotiated Rate |
$1,321.75 |
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$622.00
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$592.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$1,010.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
OP
|
$1,555.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.18 |
| 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 |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$933.00
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cash Price |
$699.75
|
| Rate for Payer: Cigna of CA PPO |
$1,150.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$1,321.75
|
| Rate for Payer: Global Benefits Group Commercial |
$933.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,166.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| 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 |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,037.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$1,244.00
|
| Rate for Payer: Networks By Design Commercial |
$1,010.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,321.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$933.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$777.50
|
| Rate for Payer: United Healthcare All Other HMO |
$777.50
|
| Rate for Payer: United Healthcare HMO Rider |
$777.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$777.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
OP
|
$9,379.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.20 |
| 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 |
$6,066.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,044.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,627.40
|
| Rate for Payer: Cash Price |
$4,220.55
|
| Rate for Payer: Cash Price |
$4,220.55
|
| Rate for Payer: Cash Price |
$4,220.55
|
| Rate for Payer: Cigna of CA PPO |
$6,940.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Dignity Health Media |
$4,044.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,448.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,459.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,044.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,044.21
|
| Rate for Payer: Galaxy Health WC |
$7,972.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,627.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,034.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,632.50
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,632.50
|
| 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 |
$4,044.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,255.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,044.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,250.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,095.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,419.24
|
| Rate for Payer: Multiplan Commercial |
$7,503.20
|
| Rate for Payer: Networks By Design Commercial |
$6,096.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,972.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,627.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,689.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,689.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,689.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,689.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,066.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,448.63
|
| Rate for Payer: Vantage Medical Group Senior |
$4,044.21
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
IP
|
$9,379.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,250.96 |
| Max. Negotiated Rate |
$7,972.15 |
| Rate for Payer: Cash Price |
$4,220.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,751.60
|
| Rate for Payer: Galaxy Health WC |
$7,972.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,627.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,255.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,573.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,250.96
|
| Rate for Payer: Multiplan Commercial |
$7,503.20
|
| Rate for Payer: Networks By Design Commercial |
$6,096.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,972.15
|
|
|
HC RESEARCH CLINIC VISIT
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC RESEARCH CLINIC VISIT
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.89
|
| Rate for Payer: Blue Distinction Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$195.30
|
| Rate for Payer: Blue Shield of California EPN |
$154.76
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Media |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC RESECTION/DEBRID PANCREAS
|
Facility
|
IP
|
$9,227.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,214.48 |
| Max. Negotiated Rate |
$7,842.95 |
| Rate for Payer: Cash Price |
$4,152.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,690.80
|
| Rate for Payer: Galaxy Health WC |
$7,842.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,536.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,154.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,515.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,214.48
|
| Rate for Payer: Multiplan Commercial |
$7,381.60
|
| Rate for Payer: Networks By Design Commercial |
$5,997.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,842.95
|
|
|
HC RESECTION/DEBRID PANCREAS
|
Facility
|
OP
|
$9,227.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,214.48 |
| Max. Negotiated Rate |
$16,179.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16,179.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,842.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,074.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,074.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,536.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$4,152.15
|
| Rate for Payer: Cash Price |
$4,152.15
|
| Rate for Payer: Cash Price |
$4,152.15
|
| Rate for Payer: Cigna of CA PPO |
$6,827.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,842.95
|
| Rate for Payer: Dignity Health Media |
$7,842.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,842.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,690.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,690.80
|
| Rate for Payer: Galaxy Health WC |
$7,842.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,536.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,920.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,154.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,230.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,214.48
|
| Rate for Payer: Multiplan Commercial |
$7,381.60
|
| Rate for Payer: Networks By Design Commercial |
$5,997.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,842.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,536.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,536.20
|
| 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 |
$7,842.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,842.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7,842.95
|
|
|
HC RESPIRATORY MINI PANEL
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
900913693
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.80 |
| Max. Negotiated Rate |
$991.59 |
| Rate for Payer: Aetna of CA HMO/PPO |
$991.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$406.44
|
| Rate for Payer: Blue Distinction Transplant |
$87.00
|
| Rate for Payer: Blue Shield of California Commercial |
$93.67
|
| Rate for Payer: Blue Shield of California EPN |
$74.24
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cigna of CA HMO |
$92.80
|
| Rate for Payer: Cigna of CA PPO |
$107.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.94
|
| Rate for Payer: Dignity Health Media |
$142.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$142.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$142.63
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$108.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$233.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$233.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$231.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$231.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$142.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$271.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$179.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.12
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.53
|
| Rate for Payer: United Healthcare All Other HMO |
$115.53
|
| Rate for Payer: United Healthcare HMO Rider |
$115.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.89
|
| Rate for Payer: Vantage Medical Group Senior |
$142.63
|
|
|
HC RESPIRATORY MINI PANEL
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 87636
|
| Hospital Charge Code |
900913693
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$144.50 |
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.00
|
| Rate for Payer: Galaxy Health WC |
$144.50
|
| Rate for Payer: Global Benefits Group Commercial |
$102.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$144.50
|
|
|
HC RESPIRATORY PANEL, NUCLEIC ACID
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900913642
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$156.00 |
| Max. Negotiated Rate |
$3,385.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,385.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,010.14
|
| Rate for Payer: Blue Distinction Transplant |
$390.00
|
| Rate for Payer: Blue Shield of California Commercial |
$419.90
|
| Rate for Payer: Blue Shield of California EPN |
$332.80
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cash Price |
$292.50
|
| Rate for Payer: Cigna of CA HMO |
$416.00
|
| Rate for Payer: Cigna of CA PPO |
$481.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Media |
$416.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$416.78
|
| Rate for Payer: Galaxy Health WC |
$552.50
|
| Rate for Payer: Global Benefits Group Commercial |
$390.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$487.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$675.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$675.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: Networks By Design Commercial |
$422.50
|
| Rate for Payer: Prime Health Services Commercial |
$552.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$390.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC RESP VIRUS PANEL NUCLEIC ACID
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 87633
|
| Hospital Charge Code |
900912337
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$48.48 |
| Max. Negotiated Rate |
$3,385.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,385.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,010.14
|
| Rate for Payer: Blue Distinction Transplant |
$121.20
|
| Rate for Payer: Blue Shield of California Commercial |
$130.49
|
| Rate for Payer: Blue Shield of California EPN |
$103.42
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna of CA HMO |
$129.28
|
| Rate for Payer: Cigna of CA PPO |
$149.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Media |
$416.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$562.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$416.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$416.78
|
| Rate for Payer: Galaxy Health WC |
$171.70
|
| Rate for Payer: Global Benefits Group Commercial |
$121.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$151.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$683.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$675.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$675.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$416.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Networks By Design Commercial |
$131.30
|
| Rate for Payer: Prime Health Services Commercial |
$171.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$121.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$121.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
