|
HC SALIVARY GLAND
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
909001145
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.63 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$193.76
|
| 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 |
$174.14
|
| Rate for Payer: Blue Distinction Transplant |
$220.20
|
| Rate for Payer: Blue Shield of California Commercial |
$216.90
|
| Rate for Payer: Blue Shield of California EPN |
$172.12
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$234.88
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| 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 |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$275.25
|
| 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 |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| 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 |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SALIV (PAROTID) SCAN
|
Facility
|
IP
|
$1,451.00
|
|
|
Service Code
|
CPT 78230
|
| Hospital Charge Code |
909301355
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$348.24 |
| Max. Negotiated Rate |
$1,233.35 |
| Rate for Payer: Cash Price |
$652.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$580.40
|
| Rate for Payer: Galaxy Health WC |
$1,233.35
|
| Rate for Payer: Global Benefits Group Commercial |
$870.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$552.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.24
|
| Rate for Payer: Multiplan Commercial |
$1,160.80
|
| Rate for Payer: Networks By Design Commercial |
$943.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,233.35
|
|
|
HC SALIV (PAROTID) SCAN
|
Facility
|
OP
|
$1,451.00
|
|
|
Service Code
|
CPT 78230
|
| Hospital Charge Code |
909301355
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$1,233.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$912.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$864.51
|
| Rate for Payer: Blue Distinction Transplant |
$870.60
|
| Rate for Payer: Blue Shield of California Commercial |
$857.54
|
| Rate for Payer: Blue Shield of California EPN |
$680.52
|
| Rate for Payer: Cash Price |
$652.95
|
| Rate for Payer: Cash Price |
$652.95
|
| Rate for Payer: Cigna of CA HMO |
$928.64
|
| Rate for Payer: Cigna of CA PPO |
$1,073.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,233.35
|
| Rate for Payer: Global Benefits Group Commercial |
$870.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,088.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$967.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$348.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,160.80
|
| Rate for Payer: Networks By Design Commercial |
$943.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,233.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$870.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$870.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC SARS COV-2 TOTAL AB
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
900912263
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$292.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$292.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.27
|
| Rate for Payer: Blue Distinction Transplant |
$33.60
|
| Rate for Payer: Blue Shield of California Commercial |
$36.18
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.20
|
| Rate for Payer: Dignity Health Media |
$42.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.88
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$42.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.13
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$69.09
|
| Rate for Payer: Heritage Provider Network Transplant |
$69.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$68.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.13
|
| Rate for Payer: United Healthcare All Other HMO |
$34.13
|
| Rate for Payer: United Healthcare HMO Rider |
$34.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.34
|
| Rate for Payer: Vantage Medical Group Senior |
$42.13
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$642.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$157.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$86.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.50
|
| Rate for Payer: Blue Distinction Transplant |
$72.00
|
| Rate for Payer: Blue Shield of California Commercial |
$88.44
|
| Rate for Payer: Blue Shield of California EPN |
$70.08
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.76
|
| Rate for Payer: Dignity Health Media |
$78.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$78.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$78.51
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$90.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$128.76
|
| Rate for Payer: Heritage Provider Network Transplant |
$128.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$127.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$78.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$98.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.20
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.36
|
| Rate for Payer: Vantage Medical Group Senior |
$78.51
|
|
|
HC SBBB CRYOPRECIPITATE IN POOL
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT P9012
|
| Hospital Charge Code |
900904012
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$102.00 |
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC SBRT
|
Facility
|
OP
|
$9,092.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
904877373
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,161.00 |
| Max. Negotiated Rate |
$10,779.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,124.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,344.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,452.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,229.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,779.79
|
| Rate for Payer: Blue Distinction Transplant |
$5,455.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,373.37
|
| Rate for Payer: Blue Shield of California EPN |
$4,264.15
|
| Rate for Payer: Cash Price |
$4,091.40
|
| Rate for Payer: Cash Price |
$4,091.40
|
| Rate for Payer: Cash Price |
$4,091.40
|
| Rate for Payer: Cigna of CA HMO |
$5,818.88
|
| Rate for Payer: Cigna of CA PPO |
$6,728.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,344.16
|
| Rate for Payer: Dignity Health Media |
$2,229.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,452.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,009.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,229.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,229.44
|
| Rate for Payer: Galaxy Health WC |
$7,728.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,455.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,819.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,656.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,656.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,611.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,611.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,229.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,064.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,820.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,229.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,182.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,809.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,987.45
|
| Rate for Payer: Multiplan Commercial |
$7,273.60
|
| Rate for Payer: Networks By Design Commercial |
$5,909.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,728.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,455.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,344.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,452.38
|
| Rate for Payer: Vantage Medical Group Senior |
$2,229.44
|
|
|
HC SBRT
|
Facility
|
IP
|
$9,092.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
904877373
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,182.08 |
| Max. Negotiated Rate |
$7,728.20 |
| Rate for Payer: Cash Price |
$4,091.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,636.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,636.80
|
| Rate for Payer: Galaxy Health WC |
$7,728.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,455.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,064.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,464.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,182.08
|
| Rate for Payer: Multiplan Commercial |
$7,273.60
|
| Rate for Payer: Networks By Design Commercial |
$5,909.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,728.20
|
|
|
HC SCAN & EVAL TESTICLE
|
Facility
|
OP
|
$2,066.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$113.58 |
| Max. Negotiated Rate |
$1,756.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$587.67
|
| 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 |
$1,230.92
|
| Rate for Payer: Blue Distinction Transplant |
$1,239.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,221.01
|
| Rate for Payer: Blue Shield of California EPN |
$968.95
|
| Rate for Payer: Cash Price |
$929.70
|
| Rate for Payer: Cash Price |
$929.70
|
| Rate for Payer: Cigna of CA HMO |
$1,322.24
|
| Rate for Payer: Cigna of CA PPO |
$1,528.84
|
| 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 |
$1,756.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,239.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,549.50
|
| 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 |
$1,378.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.84
|
| 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 |
$1,652.80
|
| Rate for Payer: Networks By Design Commercial |
$1,342.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,756.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,239.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,239.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| 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 SCAN & EVAL TESTICLE
|
Facility
|
IP
|
$2,066.00
|
|
|
Service Code
|
CPT 76870
|
| Hospital Charge Code |
906601409
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$495.84 |
| Max. Negotiated Rate |
$1,756.10 |
| Rate for Payer: Cash Price |
$929.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$826.40
|
| Rate for Payer: Galaxy Health WC |
$1,756.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,239.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,378.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$787.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$495.84
|
| Rate for Payer: Multiplan Commercial |
$1,652.80
|
| Rate for Payer: Networks By Design Commercial |
$1,342.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,756.10
|
|
|
HC SCAPULA
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC SCAPULA
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
909001479
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.64 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$135.29
|
| 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 |
$136.24
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Blue Shield of California Commercial |
$588.04
|
| Rate for Payer: Blue Shield of California EPN |
$466.66
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cigna of CA HMO |
$636.80
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| 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 |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| 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 |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| 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 |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.00
|
| 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 SCL 70 AB
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913525
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$138.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$136.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.94
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$18.09
|
| Rate for Payer: Blue Shield of California EPN |
$14.34
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$29.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$29.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
OP
|
$4,082.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$979.68 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,449.20
|
| 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 |
$1,836.90
|
| Rate for Payer: Cash Price |
$1,836.90
|
| Rate for Payer: Cigna of CA PPO |
$3,020.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Dignity Health Media |
$2,025.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,228.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$3,469.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,449.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,061.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,322.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,322.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,281.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,025.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,722.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,749.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$979.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,552.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$3,265.60
|
| Rate for Payer: Networks By Design Commercial |
$2,653.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,469.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,449.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC SCLEROTHERAPY FLUID COLLECTION
|
Facility
|
IP
|
$4,082.00
|
|
|
Service Code
|
CPT 49185
|
| Hospital Charge Code |
909049185
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$979.68 |
| Max. Negotiated Rate |
$3,469.70 |
| Rate for Payer: Cash Price |
$1,836.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,632.80
|
| Rate for Payer: Galaxy Health WC |
$3,469.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,449.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,722.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$979.68
|
| Rate for Payer: Multiplan Commercial |
$3,265.60
|
| Rate for Payer: Networks By Design Commercial |
$2,653.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,469.70
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
IP
|
$468.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.32 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.20
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.32
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
|
|
HC SCRAPING OF CORNEA, DIAG/SMEAR
|
Facility
|
OP
|
$468.00
|
|
|
Service Code
|
CPT 65430
|
| Hospital Charge Code |
900501649
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.32 |
| 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 |
$746.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$497.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$280.80
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna of CA PPO |
$346.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$746.73
|
| Rate for Payer: Dignity Health Media |
$497.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$547.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.06
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$497.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$497.82
|
| Rate for Payer: Galaxy Health WC |
$397.80
|
| Rate for Payer: Global Benefits Group Commercial |
$280.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$351.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$816.42
|
| Rate for Payer: Heritage Provider Network Transplant |
$816.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$497.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$261.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$497.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.08
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Networks By Design Commercial |
$304.20
|
| Rate for Payer: Prime Health Services Commercial |
$397.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$280.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.00
|
| Rate for Payer: United Healthcare All Other HMO |
$234.00
|
| Rate for Payer: United Healthcare HMO Rider |
$234.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$746.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$547.60
|
| Rate for Payer: Vantage Medical Group Senior |
$497.82
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
OP
|
$1,379.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$330.96 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$758.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$758.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$821.61
|
| Rate for Payer: Blue Distinction Transplant |
$827.40
|
| Rate for Payer: Blue Shield of California Commercial |
$814.99
|
| Rate for Payer: Blue Shield of California EPN |
$646.75
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cash Price |
$620.55
|
| Rate for Payer: Cigna of CA HMO |
$882.56
|
| Rate for Payer: Cigna of CA PPO |
$1,020.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Dignity Health Media |
$1,172.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,172.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$551.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$551.60
|
| Rate for Payer: Galaxy Health WC |
$1,172.15
|
| Rate for Payer: Global Benefits Group Commercial |
$827.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,034.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$919.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.96
|
| Rate for Payer: Multiplan Commercial |
$1,103.20
|
| Rate for Payer: Networks By Design Commercial |
$896.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,172.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$827.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$827.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,781.07
|
| Rate for Payer: United Healthcare All Other HMO |
$1,781.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,781.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,781.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,172.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,172.15
|
|
|
HC SCRENG VIRTUAL CT COLONOGRAPHY
|
Facility
|
IP
|
$2,457.00
|
|
|
Service Code
|
CPT 74263
|
| Hospital Charge Code |
909201972
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$2,088.45 |
| Rate for Payer: Cash Price |
$1,105.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.80
|
| Rate for Payer: Galaxy Health WC |
$2,088.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.68
|
| Rate for Payer: Multiplan Commercial |
$1,965.60
|
| Rate for Payer: Networks By Design Commercial |
$1,597.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,088.45
|
|
|
HC SCRNG PRFMD AND NEG LOW RSK
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT G9920
|
| Hospital Charge Code |
902506920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC SCRNG PRFMD AND NEG LOW RSK
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT G9920
|
| Hospital Charge Code |
902506920
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.90
|
| Rate for Payer: Blue Distinction Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$53.06
|
| Rate for Payer: Blue Shield of California EPN |
$42.05
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Media |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC SCRNG PRFMD AND POS HIGH RSK
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT G9919
|
| Hospital Charge Code |
902506919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.28 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC SCRNG PRFMD AND POS HIGH RSK
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT G9919
|
| Hospital Charge Code |
902506919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.90
|
| Rate for Payer: Blue Distinction Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$53.06
|
| Rate for Payer: Blue Shield of California EPN |
$42.05
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.20
|
| Rate for Payer: Dignity Health Media |
$61.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.00
|
| Rate for Payer: United Healthcare All Other HMO |
$36.00
|
| Rate for Payer: United Healthcare HMO Rider |
$36.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.20
|
| Rate for Payer: Vantage Medical Group Senior |
$61.20
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
OP
|
$1,492.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$358.08 |
| Max. Negotiated Rate |
$1,268.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$978.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,268.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$820.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$820.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$888.93
|
| Rate for Payer: Blue Distinction Transplant |
$895.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,099.60
|
| Rate for Payer: Blue Shield of California EPN |
$871.33
|
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: Cigna of CA HMO |
$954.88
|
| Rate for Payer: Cigna of CA PPO |
$1,104.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,268.20
|
| Rate for Payer: Dignity Health Media |
$1,268.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,268.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$596.80
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,119.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.08
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$895.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$895.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$746.00
|
| Rate for Payer: United Healthcare All Other HMO |
$746.00
|
| Rate for Payer: United Healthcare HMO Rider |
$746.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$746.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,268.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,268.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,268.20
|
|
|
HC SD RECOVERY LEVEL IV FIRST HR
|
Facility
|
IP
|
$1,492.00
|
|
| Hospital Charge Code |
906500107
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$358.08 |
| Max. Negotiated Rate |
$1,268.20 |
| Rate for Payer: Cash Price |
$671.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$596.80
|
| Rate for Payer: Galaxy Health WC |
$1,268.20
|
| Rate for Payer: Global Benefits Group Commercial |
$895.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$995.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.08
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Networks By Design Commercial |
$969.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,268.20
|
|
