|
HC RESTING THALLIUM
|
Facility
|
IP
|
$3,719.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301384
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$892.56 |
| Max. Negotiated Rate |
$3,161.15 |
| Rate for Payer: Cash Price |
$1,673.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,487.60
|
| Rate for Payer: Galaxy Health WC |
$3,161.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,231.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,416.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.56
|
| Rate for Payer: Multiplan Commercial |
$2,975.20
|
| Rate for Payer: Networks By Design Commercial |
$2,417.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,161.15
|
|
|
HC RESTING THALLIUM
|
Facility
|
OP
|
$3,719.00
|
|
|
Service Code
|
CPT 78453
|
| Hospital Charge Code |
909301384
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$335.54 |
| Max. Negotiated Rate |
$3,161.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,557.29
|
| 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 |
$2,215.78
|
| Rate for Payer: Blue Distinction Transplant |
$2,231.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,197.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,744.21
|
| Rate for Payer: Cash Price |
$1,673.55
|
| Rate for Payer: Cash Price |
$1,673.55
|
| Rate for Payer: Cigna of CA HMO |
$2,380.16
|
| Rate for Payer: Cigna of CA PPO |
$2,752.06
|
| 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 |
$3,161.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,231.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,789.25
|
| 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 |
$2,480.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.56
|
| 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 |
$2,975.20
|
| Rate for Payer: Networks By Design Commercial |
$2,417.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,161.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,231.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,231.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,721.55
|
| Rate for Payer: United Healthcare All Other HMO |
$1,721.55
|
| Rate for Payer: United Healthcare HMO Rider |
$1,721.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,721.55
|
| 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 RESUSCITATOR MANUAL ADULT SZ S
|
Facility
|
IP
|
$78.47
|
|
| Hospital Charge Code |
901698786
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$66.70 |
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.39
|
| Rate for Payer: Galaxy Health WC |
$66.70
|
| Rate for Payer: Global Benefits Group Commercial |
$47.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.83
|
| Rate for Payer: Multiplan Commercial |
$62.78
|
| Rate for Payer: Networks By Design Commercial |
$51.01
|
| Rate for Payer: Prime Health Services Commercial |
$66.70
|
|
|
HC RESUSCITATOR MANUAL ADULT SZ S
|
Facility
|
OP
|
$78.47
|
|
| Hospital Charge Code |
901698786
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.83 |
| Max. Negotiated Rate |
$66.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$51.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$66.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.75
|
| Rate for Payer: Blue Distinction Transplant |
$47.08
|
| Rate for Payer: Blue Shield of California Commercial |
$57.83
|
| Rate for Payer: Blue Shield of California EPN |
$45.83
|
| Rate for Payer: Cash Price |
$35.31
|
| Rate for Payer: Cigna of CA HMO |
$50.22
|
| Rate for Payer: Cigna of CA PPO |
$58.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$66.70
|
| Rate for Payer: Dignity Health Media |
$66.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.39
|
| Rate for Payer: Galaxy Health WC |
$66.70
|
| Rate for Payer: Global Benefits Group Commercial |
$47.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$58.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.83
|
| Rate for Payer: Multiplan Commercial |
$62.78
|
| Rate for Payer: Networks By Design Commercial |
$51.01
|
| Rate for Payer: Prime Health Services Commercial |
$66.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.08
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.08
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.24
|
| Rate for Payer: United Healthcare All Other HMO |
$39.24
|
| Rate for Payer: United Healthcare HMO Rider |
$39.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$66.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.70
|
| Rate for Payer: Vantage Medical Group Senior |
$66.70
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.51 |
| Max. Negotiated Rate |
$50.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.74
|
| Rate for Payer: Blue Distinction Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13.57
|
| Rate for Payer: Blue Shield of California EPN |
$10.75
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Media |
$5.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$39.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.25
|
| Rate for Payer: Blue Distinction Transplant |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$15.50
|
| Rate for Payer: Blue Shield of California EPN |
$12.29
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Media |
$4.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.31
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
OP
|
$6,278.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$499.40 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$726.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,766.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,825.10
|
| Rate for Payer: Cash Price |
$2,825.10
|
| Rate for Payer: Cigna of CA PPO |
$4,645.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Dignity Health Media |
$726.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$726.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$726.26
|
| Rate for Payer: Galaxy Health WC |
$5,336.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,766.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,708.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,191.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,191.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,176.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,176.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$726.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,506.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$915.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.19
|
| Rate for Payer: Multiplan Commercial |
$5,022.40
|
| Rate for Payer: Networks By Design Commercial |
$4,080.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,336.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,766.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Vantage Medical Group Senior |
$726.26
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
IP
|
$6,278.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,506.72 |
| Max. Negotiated Rate |
$5,336.30 |
| Rate for Payer: Cash Price |
$2,825.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,511.20
|
| Rate for Payer: Galaxy Health WC |
$5,336.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,766.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,187.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,391.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,506.72
|
| Rate for Payer: Multiplan Commercial |
$5,022.40
|
| Rate for Payer: Networks By Design Commercial |
$4,080.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,336.30
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.68 |
| Max. Negotiated Rate |
$643.45 |
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.80
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.68
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$181.68 |
| 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 |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$454.20
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cigna of CA PPO |
$560.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$567.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$596.93
|
| 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 |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$605.60
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$454.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$378.50
|
| Rate for Payer: United Healthcare All Other HMO |
$378.50
|
| Rate for Payer: United Healthcare HMO Rider |
$378.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$378.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
OP
|
$5,782.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,444.92
|
| Rate for Payer: Blue Distinction Transplant |
$3,469.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$4,278.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$4,914.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,469.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,336.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,856.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,625.60
|
| Rate for Payer: Networks By Design Commercial |
$3,758.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,914.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
IP
|
$5,782.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,387.68 |
| Max. Negotiated Rate |
$4,914.70 |
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,312.80
|
| Rate for Payer: Galaxy Health WC |
$4,914.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,469.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,856.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,202.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.68
|
| Rate for Payer: Multiplan Commercial |
$4,625.60
|
| Rate for Payer: Networks By Design Commercial |
$3,758.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,914.70
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
OP
|
$5,782.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,444.92
|
| Rate for Payer: Blue Distinction Transplant |
$3,469.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: Cigna of CA PPO |
$4,278.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$4,914.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,469.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,336.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,857.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,834.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,856.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,427.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$4,625.60
|
| Rate for Payer: Networks By Design Commercial |
$3,758.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,914.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
IP
|
$5,782.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,387.68 |
| Max. Negotiated Rate |
$4,914.70 |
| Rate for Payer: Cash Price |
$2,601.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,312.80
|
| Rate for Payer: Galaxy Health WC |
$4,914.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,469.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,856.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,202.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.68
|
| Rate for Payer: Multiplan Commercial |
$4,625.60
|
| Rate for Payer: Networks By Design Commercial |
$3,758.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,914.70
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
IP
|
$1,281.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$307.44 |
| Max. Negotiated Rate |
$1,088.85 |
| Rate for Payer: Cash Price |
$576.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.40
|
| Rate for Payer: Galaxy Health WC |
$1,088.85
|
| Rate for Payer: Global Benefits Group Commercial |
$768.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$854.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.44
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: Networks By Design Commercial |
$832.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,088.85
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
OP
|
$1,281.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$1,120.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,120.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.29
|
| Rate for Payer: Blue Distinction Transplant |
$768.60
|
| Rate for Payer: Blue Shield of California Commercial |
$757.07
|
| Rate for Payer: Blue Shield of California EPN |
$600.79
|
| Rate for Payer: Cash Price |
$576.45
|
| Rate for Payer: Cash Price |
$576.45
|
| Rate for Payer: Cigna of CA HMO |
$819.84
|
| Rate for Payer: Cigna of CA PPO |
$947.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,088.85
|
| Rate for Payer: Global Benefits Group Commercial |
$768.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$960.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$854.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,024.80
|
| Rate for Payer: Networks By Design Commercial |
$832.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,088.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$768.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$768.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
IP
|
$1,083.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.92 |
| Max. Negotiated Rate |
$920.55 |
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$433.20
|
| Rate for Payer: Galaxy Health WC |
$920.55
|
| Rate for Payer: Global Benefits Group Commercial |
$649.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$722.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$412.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.92
|
| Rate for Payer: Multiplan Commercial |
$866.40
|
| Rate for Payer: Networks By Design Commercial |
$703.95
|
| Rate for Payer: Prime Health Services Commercial |
$920.55
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
OP
|
$1,083.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$1,120.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,120.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$600.67
|
| Rate for Payer: Blue Distinction Transplant |
$649.80
|
| Rate for Payer: Blue Shield of California Commercial |
$640.05
|
| Rate for Payer: Blue Shield of California EPN |
$507.93
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Cash Price |
$487.35
|
| Rate for Payer: Cigna of CA HMO |
$693.12
|
| Rate for Payer: Cigna of CA PPO |
$801.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$920.55
|
| Rate for Payer: Global Benefits Group Commercial |
$649.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$812.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$788.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$778.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$722.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$605.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$866.40
|
| Rate for Payer: Networks By Design Commercial |
$703.95
|
| Rate for Payer: Prime Health Services Commercial |
$920.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$649.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$649.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$35,850.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,604.00 |
| Max. Negotiated Rate |
$30,472.50 |
| Rate for Payer: Cash Price |
$16,132.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,340.00
|
| Rate for Payer: Galaxy Health WC |
$30,472.50
|
| Rate for Payer: Global Benefits Group Commercial |
$21,510.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,911.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,658.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,604.00
|
| Rate for Payer: Multiplan Commercial |
$28,680.00
|
| Rate for Payer: Networks By Design Commercial |
$23,302.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,472.50
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$35,850.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$474.73 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,628.00
|
| Rate for Payer: Blue Distinction Transplant |
$21,510.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$16,132.50
|
| Rate for Payer: Cash Price |
$16,132.50
|
| Rate for Payer: Cigna of CA PPO |
$26,529.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$30,472.50
|
| Rate for Payer: Global Benefits Group Commercial |
$21,510.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26,887.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,711.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,711.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,568.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,911.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,604.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,998.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$28,680.00
|
| Rate for Payer: Networks By Design Commercial |
$23,302.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,472.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
|
HC REVISION OF EYELID
|
Facility
|
IP
|
$3,749.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$899.76 |
| Max. Negotiated Rate |
$3,186.65 |
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,499.60
|
| Rate for Payer: Galaxy Health WC |
$3,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,249.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,500.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,428.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.76
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: Networks By Design Commercial |
$2,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,186.65
|
|
|
HC REVISION OF EYELID
|
Facility
|
OP
|
$3,749.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.98 |
| Max. Negotiated Rate |
$3,186.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,249.40
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Cigna of CA PPO |
$2,774.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$3,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,249.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,811.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$596.93
|
| 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 |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,500.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: Networks By Design Commercial |
$2,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,186.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,249.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,874.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,874.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,874.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,874.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
IP
|
$6,415.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,539.60 |
| Max. Negotiated Rate |
$5,452.75 |
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,566.00
|
| Rate for Payer: Galaxy Health WC |
$5,452.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,849.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,444.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.60
|
| Rate for Payer: Multiplan Commercial |
$5,132.00
|
| Rate for Payer: Networks By Design Commercial |
$4,169.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,452.75
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
OP
|
$6,415.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$867.90 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,849.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,128.35
|
| Rate for Payer: Blue Shield of California EPN |
$2,686.96
|
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: Cash Price |
$2,886.75
|
| Rate for Payer: Cigna of CA PPO |
$4,747.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$5,452.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,849.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,811.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,956.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,908.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,278.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,039.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$5,132.00
|
| Rate for Payer: Networks By Design Commercial |
$4,169.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,452.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,849.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
OP
|
$2,729.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,319.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,500.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,500.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,637.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cash Price |
$1,228.05
|
| Rate for Payer: Cigna of CA PPO |
$2,019.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,319.65
|
| Rate for Payer: Dignity Health Media |
$2,319.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,319.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,091.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,091.60
|
| Rate for Payer: Galaxy Health WC |
$2,319.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,637.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,046.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,820.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.96
|
| Rate for Payer: Multiplan Commercial |
$2,183.20
|
| Rate for Payer: Networks By Design Commercial |
$1,773.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,319.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,637.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,319.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,319.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,319.65
|
|
