|
HC RPR PROS DEVICE PER 15 MIN
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT L7520
|
| Hospital Charge Code |
905357520
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$13.60 |
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.40
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
|
|
HC RPR TITER
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900910929
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$40.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.17
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Media |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
|
|
HC RSPR T-POD PELVIC STBL
|
Facility
|
OP
|
$585.12
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901698449
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$59.28 |
| Max. Negotiated Rate |
$497.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$497.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$321.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$348.61
|
| Rate for Payer: Blue Distinction Transplant |
$351.07
|
| Rate for Payer: Blue Shield of California Commercial |
$431.23
|
| Rate for Payer: Blue Shield of California EPN |
$341.71
|
| Rate for Payer: Cash Price |
$263.30
|
| Rate for Payer: Cash Price |
$263.30
|
| Rate for Payer: Cigna of CA HMO |
$374.48
|
| Rate for Payer: Cigna of CA PPO |
$432.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$497.35
|
| Rate for Payer: Dignity Health Media |
$497.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$497.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$234.05
|
| Rate for Payer: Galaxy Health WC |
$497.35
|
| Rate for Payer: Global Benefits Group Commercial |
$351.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$438.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.43
|
| Rate for Payer: Multiplan Commercial |
$468.10
|
| Rate for Payer: Networks By Design Commercial |
$380.33
|
| Rate for Payer: Prime Health Services Commercial |
$497.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.56
|
| Rate for Payer: United Healthcare All Other HMO |
$292.56
|
| Rate for Payer: United Healthcare HMO Rider |
$292.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$292.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$497.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$497.35
|
| Rate for Payer: Vantage Medical Group Senior |
$497.35
|
|
|
HC RSPR T-POD PELVIC STBL
|
Facility
|
IP
|
$585.12
|
|
|
Service Code
|
CPT E0944
|
| Hospital Charge Code |
901698449
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$140.43 |
| Max. Negotiated Rate |
$497.35 |
| Rate for Payer: Cash Price |
$263.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.05
|
| Rate for Payer: Galaxy Health WC |
$497.35
|
| Rate for Payer: Global Benefits Group Commercial |
$351.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$390.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.43
|
| Rate for Payer: Multiplan Commercial |
$468.10
|
| Rate for Payer: Networks By Design Commercial |
$380.33
|
| Rate for Payer: Prime Health Services Commercial |
$497.35
|
|
|
HC RSV AG
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.55 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.00
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.80
|
| Rate for Payer: Blue Shield of California EPN |
$13.31
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.86
|
| Rate for Payer: Dignity Health Media |
$13.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.91
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.91
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.81
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.27
|
| Rate for Payer: United Healthcare All Other HMO |
$11.27
|
| Rate for Payer: United Healthcare HMO Rider |
$11.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$13.91
|
|
|
HC RSV DFA
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$82.00
|
| Rate for Payer: Blue Distinction Transplant |
$21.60
|
| Rate for Payer: Blue Shield of California Commercial |
$23.26
|
| Rate for Payer: Blue Shield of California EPN |
$18.43
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Media |
$13.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.42
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
OP
|
$1,271.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$1,080.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$420.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,080.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$699.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$699.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$757.26
|
| Rate for Payer: Blue Distinction Transplant |
$762.60
|
| Rate for Payer: Blue Shield of California Commercial |
$751.16
|
| Rate for Payer: Blue Shield of California EPN |
$596.10
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Cigna of CA HMO |
$813.44
|
| Rate for Payer: Cigna of CA PPO |
$940.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,080.35
|
| Rate for Payer: Dignity Health Media |
$1,080.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,080.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$508.40
|
| Rate for Payer: Galaxy Health WC |
$1,080.35
|
| Rate for Payer: Global Benefits Group Commercial |
$762.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$953.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$847.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.04
|
| Rate for Payer: Multiplan Commercial |
$1,016.80
|
| Rate for Payer: Networks By Design Commercial |
$826.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,080.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$762.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$762.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,080.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,080.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,080.35
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
IP
|
$1,271.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$305.04 |
| Max. Negotiated Rate |
$1,080.35 |
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.40
|
| Rate for Payer: Galaxy Health WC |
$1,080.35
|
| Rate for Payer: Global Benefits Group Commercial |
$762.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$847.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.04
|
| Rate for Payer: Multiplan Commercial |
$1,016.80
|
| Rate for Payer: Networks By Design Commercial |
$826.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,080.35
|
|
|
HC RUBELLA ADMINISTRATION
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
908603009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$24.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.64
|
| Rate for Payer: Blue Distinction Transplant |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$28.01
|
| Rate for Payer: Blue Shield of California EPN |
$22.19
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Media |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC RUBELLA ADMINISTRATION
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
908603009
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.12 |
| Max. Negotiated Rate |
$32.30 |
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.12
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC RUBELLA ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913664
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$130.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.89
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Media |
$14.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC RUBELLA ANTIBODY IGG QUANT
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
900913665
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$130.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.89
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Media |
$14.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC RUBEOLA ANTIBODY
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913666
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.57
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Media |
$12.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
IP
|
$31,516.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,563.84 |
| Max. Negotiated Rate |
$26,788.60 |
| Rate for Payer: Cash Price |
$14,182.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,606.40
|
| Rate for Payer: Galaxy Health WC |
$26,788.60
|
| Rate for Payer: Global Benefits Group Commercial |
$18,909.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,021.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,007.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,563.84
|
| Rate for Payer: Multiplan Commercial |
$25,212.80
|
| Rate for Payer: Networks By Design Commercial |
$20,485.40
|
| Rate for Payer: Prime Health Services Commercial |
$26,788.60
|
|
|
HC SACRAL AUGMENTATION BILAT
|
Facility
|
OP
|
$31,516.00
|
|
|
Service Code
|
CPT 0201T
|
| Hospital Charge Code |
909020153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$26,788.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,952.20
|
| 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 |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$18,909.60
|
| 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 |
$14,182.20
|
| Rate for Payer: Cash Price |
$14,182.20
|
| Rate for Payer: Cigna of CA PPO |
$23,321.84
|
| 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 |
$26,788.60
|
| Rate for Payer: Global Benefits Group Commercial |
$18,909.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23,637.00
|
| 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 |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,021.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,007.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,563.84
|
| 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 |
$25,212.80
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$20,485.40
|
| Rate for Payer: Prime Health Services Commercial |
$26,788.60
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,909.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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 SACRAL AUGMENTATION UNILAT
|
Facility
|
OP
|
$16,976.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,756.86 |
| Max. Negotiated Rate |
$20,338.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,338.45
|
| 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 |
$8,049.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,185.60
|
| 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 |
$7,639.20
|
| Rate for Payer: Cash Price |
$7,639.20
|
| Rate for Payer: Cigna of CA PPO |
$12,562.24
|
| 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 |
$14,429.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,185.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,732.00
|
| 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 |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$14,480.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,322.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,467.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,074.24
|
| 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 |
$13,580.80
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$11,034.40
|
| Rate for Payer: Prime Health Services Commercial |
$14,429.60
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,185.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| 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 SACRAL AUGMENTATION UNILAT
|
Facility
|
IP
|
$16,976.00
|
|
|
Service Code
|
CPT 0200T
|
| Hospital Charge Code |
909020152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,074.24 |
| Max. Negotiated Rate |
$14,429.60 |
| Rate for Payer: Cash Price |
$7,639.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,790.40
|
| Rate for Payer: Galaxy Health WC |
$14,429.60
|
| Rate for Payer: Global Benefits Group Commercial |
$10,185.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,322.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,467.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,074.24
|
| Rate for Payer: Multiplan Commercial |
$13,580.80
|
| Rate for Payer: Networks By Design Commercial |
$11,034.40
|
| Rate for Payer: Prime Health Services Commercial |
$14,429.60
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
OP
|
$2,514.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$558.11 |
| 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 |
$2,136.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,382.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,382.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,508.40
|
| 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 |
$1,131.30
|
| Rate for Payer: Cash Price |
$1,131.30
|
| Rate for Payer: Cigna of CA PPO |
$1,860.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,136.90
|
| Rate for Payer: Dignity Health Media |
$2,136.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,136.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,005.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,005.60
|
| Rate for Payer: Galaxy Health WC |
$2,136.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,508.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,885.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,676.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.36
|
| Rate for Payer: Multiplan Commercial |
$2,011.20
|
| Rate for Payer: Networks By Design Commercial |
$1,634.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,136.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,508.40
|
| 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 |
$2,136.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,136.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,136.90
|
|
|
HC SACROILIAC ARTHROGRAPHY
|
Facility
|
IP
|
$2,514.00
|
|
|
Service Code
|
CPT 27096
|
| Hospital Charge Code |
909000223
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$603.36 |
| Max. Negotiated Rate |
$2,136.90 |
| Rate for Payer: Cash Price |
$1,131.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,005.60
|
| Rate for Payer: Galaxy Health WC |
$2,136.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,508.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,676.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$957.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$603.36
|
| Rate for Payer: Multiplan Commercial |
$2,011.20
|
| Rate for Payer: Networks By Design Commercial |
$1,634.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,136.90
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$247.68 |
| Max. Negotiated Rate |
$877.20 |
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.80
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$688.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.68
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: Networks By Design Commercial |
$670.80
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
|
|
HC SACRO ILIAC JOINTS
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
909001344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.18 |
| Max. Negotiated Rate |
$877.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$161.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.61
|
| Rate for Payer: Blue Distinction Transplant |
$619.20
|
| Rate for Payer: Blue Shield of California Commercial |
$609.91
|
| Rate for Payer: Blue Shield of California EPN |
$484.01
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cash Price |
$464.40
|
| Rate for Payer: Cigna of CA HMO |
$660.48
|
| Rate for Payer: Cigna of CA PPO |
$763.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$877.20
|
| Rate for Payer: Global Benefits Group Commercial |
$619.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$774.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$222.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$688.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$825.60
|
| Rate for Payer: Networks By Design Commercial |
$670.80
|
| Rate for Payer: Prime Health Services Commercial |
$877.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$619.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$619.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SACRUM AND COCCYX
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.54 |
| Max. Negotiated Rate |
$810.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$133.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.89
|
| Rate for Payer: Blue Distinction Transplant |
$571.80
|
| Rate for Payer: Blue Shield of California Commercial |
$563.22
|
| Rate for Payer: Blue Shield of California EPN |
$446.96
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Cigna of CA HMO |
$609.92
|
| Rate for Payer: Cigna of CA PPO |
$705.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$810.05
|
| Rate for Payer: Global Benefits Group Commercial |
$571.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$714.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$635.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: Networks By Design Commercial |
$619.45
|
| Rate for Payer: Prime Health Services Commercial |
$810.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$571.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SACRUM AND COCCYX
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
909001343
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.72 |
| Max. Negotiated Rate |
$810.05 |
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.20
|
| Rate for Payer: Galaxy Health WC |
$810.05
|
| Rate for Payer: Global Benefits Group Commercial |
$571.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$635.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.72
|
| Rate for Payer: Multiplan Commercial |
$762.40
|
| Rate for Payer: Networks By Design Commercial |
$619.45
|
| Rate for Payer: Prime Health Services Commercial |
$810.05
|
|
|
HC SALICYLATES
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910366
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.44 |
| Max. Negotiated Rate |
$562.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.21
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$20.03
|
| Rate for Payer: Blue Shield of California EPN |
$15.87
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Media |
$62.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$100.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC SALIVARY GLAND
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
909001145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
