|
HC SENSORY NERVE CONDUCTION STUDY
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
900600258
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$1,231.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$142.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$119.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.29
|
| Rate for Payer: Blue Distinction Transplant |
$130.20
|
| Rate for Payer: Blue Shield of California Commercial |
$128.25
|
| Rate for Payer: Blue Shield of California EPN |
$101.77
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cash Price |
$97.65
|
| Rate for Payer: Cigna of CA HMO |
$138.88
|
| Rate for Payer: Cigna of CA PPO |
$160.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$184.45
|
| Rate for Payer: Dignity Health Media |
$184.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$184.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$86.80
|
| Rate for Payer: Galaxy Health WC |
$184.45
|
| Rate for Payer: Global Benefits Group Commercial |
$130.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.08
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Networks By Design Commercial |
$141.05
|
| Rate for Payer: Prime Health Services Commercial |
$184.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$184.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$184.45
|
| Rate for Payer: Vantage Medical Group Senior |
$184.45
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
OP
|
$303.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$72.72 |
| Max. Negotiated Rate |
$654.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$654.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$166.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$181.80
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: Cigna of CA HMO |
$193.92
|
| Rate for Payer: Cigna of CA PPO |
$224.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$257.55
|
| Rate for Payer: Dignity Health Media |
$257.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$257.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$227.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$225.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$257.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$257.55
|
| Rate for Payer: Vantage Medical Group Senior |
$257.55
|
|
|
HC SENSORY TEST ENDOSCOP SWALLOW MCAL
|
Facility
|
IP
|
$303.00
|
|
|
Service Code
|
CPT 92616
|
| Hospital Charge Code |
907000034
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$72.72 |
| Max. Negotiated Rate |
$257.55 |
| Rate for Payer: Cash Price |
$136.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$121.20
|
| Rate for Payer: Galaxy Health WC |
$257.55
|
| Rate for Payer: Global Benefits Group Commercial |
$181.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$202.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$242.40
|
| Rate for Payer: Networks By Design Commercial |
$196.95
|
| Rate for Payer: Prime Health Services Commercial |
$257.55
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
IP
|
$3,518.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$844.32 |
| Max. Negotiated Rate |
$2,990.30 |
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,407.20
|
| Rate for Payer: Galaxy Health WC |
$2,990.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,110.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,346.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,340.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.32
|
| Rate for Payer: Multiplan Commercial |
$2,814.40
|
| Rate for Payer: Networks By Design Commercial |
$2,286.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,990.30
|
|
|
HC SEP UPPER AND LOWER LIMBS
|
Facility
|
OP
|
$3,518.00
|
|
|
Service Code
|
CPT 95938
|
| Hospital Charge Code |
900600624
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$508.57 |
| Max. Negotiated Rate |
$2,990.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,746.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,096.02
|
| Rate for Payer: Blue Distinction Transplant |
$2,110.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,079.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,649.94
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cash Price |
$1,583.10
|
| Rate for Payer: Cigna of CA HMO |
$2,251.52
|
| Rate for Payer: Cigna of CA PPO |
$2,603.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$2,990.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,110.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,638.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,098.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,084.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,346.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$844.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$843.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$2,814.40
|
| Rate for Payer: Networks By Design Commercial |
$2,286.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,990.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,110.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$340.20
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cigna of CA PPO |
$419.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$425.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| 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 |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$340.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC SHIGATOXIN
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
900912326
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$84.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.70
|
| Rate for Payer: Blue Distinction Transplant |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$29.72
|
| Rate for Payer: Blue Shield of California EPN |
$23.55
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.97
|
| Rate for Payer: Dignity Health Media |
$11.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.98
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$19.65
|
| Rate for Payer: Heritage Provider Network Transplant |
$19.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$19.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.05
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.70
|
| Rate for Payer: United Healthcare All Other HMO |
$9.70
|
| Rate for Payer: United Healthcare HMO Rider |
$9.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.18
|
| Rate for Payer: Vantage Medical Group Senior |
$11.98
|
|
|
HC SHOULDER ARTHROGRAPHY INJ
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
909000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.12 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$542.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$350.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$350.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$382.80
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$542.30
|
| Rate for Payer: Dignity Health Media |
$542.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$542.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$478.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$327.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| 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 |
$542.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$542.30
|
| Rate for Payer: Vantage Medical Group Senior |
$542.30
|
|
|
HC SHOULDER ARTHROGRAPHY INJ
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 23350
|
| Hospital Charge Code |
909000113
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.12 |
| Max. Negotiated Rate |
$542.30 |
| Rate for Payer: Cash Price |
$287.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC SHOULDER COMPLETE UNILAT
|
Facility
|
OP
|
$955.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
909001504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.13 |
| Max. Negotiated Rate |
$811.75 |
| 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 |
$573.00
|
| Rate for Payer: Blue Shield of California Commercial |
$564.40
|
| Rate for Payer: Blue Shield of California EPN |
$447.90
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: Cigna of CA HMO |
$611.20
|
| Rate for Payer: Cigna of CA PPO |
$706.70
|
| 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 |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$716.25
|
| 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 |
$636.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.20
|
| 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 |
$764.00
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$573.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$573.00
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SHOULDER COMPLETE UNILAT
|
Facility
|
IP
|
$955.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
909001504
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.20 |
| Max. Negotiated Rate |
$811.75 |
| Rate for Payer: Cash Price |
$429.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$382.00
|
| Rate for Payer: Galaxy Health WC |
$811.75
|
| Rate for Payer: Global Benefits Group Commercial |
$573.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.20
|
| Rate for Payer: Multiplan Commercial |
$764.00
|
| Rate for Payer: Networks By Design Commercial |
$620.75
|
| Rate for Payer: Prime Health Services Commercial |
$811.75
|
|
|
HC SHOULDER LIMITED
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
909001505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.87 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$102.82
|
| 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 |
$123.59
|
| Rate for Payer: Blue Distinction Transplant |
$483.00
|
| Rate for Payer: Blue Shield of California Commercial |
$475.76
|
| Rate for Payer: Blue Shield of California EPN |
$377.54
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cigna of CA HMO |
$515.20
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| 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 |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$603.75
|
| 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 |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| 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 |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$483.00
|
| 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 |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC SHOULDER LIMITED
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT 73020
|
| Hospital Charge Code |
909001505
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$684.25 |
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$644.00
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC SHUNT EVALUATION
|
Facility
|
IP
|
$2,837.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$680.88 |
| Max. Negotiated Rate |
$2,411.45 |
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,134.80
|
| Rate for Payer: Galaxy Health WC |
$2,411.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,080.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$680.88
|
| Rate for Payer: Multiplan Commercial |
$2,269.60
|
| Rate for Payer: Networks By Design Commercial |
$1,844.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,411.45
|
|
|
HC SHUNT EVALUATION
|
Facility
|
OP
|
$2,837.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$283.78 |
| Max. Negotiated Rate |
$2,411.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,529.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,690.28
|
| Rate for Payer: Blue Distinction Transplant |
$1,702.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,676.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,330.55
|
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: Cash Price |
$1,276.65
|
| Rate for Payer: Cigna of CA HMO |
$1,815.68
|
| Rate for Payer: Cigna of CA PPO |
$2,099.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$2,411.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,127.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,892.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$680.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,269.60
|
| Rate for Payer: Networks By Design Commercial |
$1,844.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,411.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,702.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,702.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC SHUNTOGRAM
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$47.18 |
| Max. Negotiated Rate |
$824.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$472.96
|
| 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 |
$204.97
|
| Rate for Payer: Blue Distinction Transplant |
$582.00
|
| Rate for Payer: Blue Shield of California Commercial |
$573.27
|
| Rate for Payer: Blue Shield of California EPN |
$454.93
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna of CA HMO |
$620.80
|
| Rate for Payer: Cigna of CA PPO |
$717.80
|
| 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 |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$727.50
|
| 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 |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.80
|
| 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 |
$776.00
|
| Rate for Payer: Networks By Design Commercial |
$630.50
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$582.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| 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 SHUNTOGRAM
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$824.50 |
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.00
|
| Rate for Payer: Galaxy Health WC |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.80
|
| Rate for Payer: Multiplan Commercial |
$776.00
|
| Rate for Payer: Networks By Design Commercial |
$630.50
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
|
|
HC SIALOGRAM
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.52 |
| Max. Negotiated Rate |
$444.55 |
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$209.20
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.52
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
|
|
HC SIALOGRAM
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.53 |
| Max. Negotiated Rate |
$605.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$527.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$463.94
|
| Rate for Payer: Blue Distinction Transplant |
$313.80
|
| Rate for Payer: Blue Shield of California Commercial |
$309.09
|
| Rate for Payer: Blue Shield of California EPN |
$245.29
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cash Price |
$235.35
|
| Rate for Payer: Cigna of CA HMO |
$334.72
|
| Rate for Payer: Cigna of CA PPO |
$387.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$444.55
|
| Rate for Payer: Global Benefits Group Commercial |
$313.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$392.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$125.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Networks By Design Commercial |
$339.95
|
| Rate for Payer: Prime Health Services Commercial |
$444.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
OP
|
$3,031.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.27 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,818.60
|
| 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 |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cigna of CA PPO |
$2,242.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$2,576.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,818.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,273.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,113.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,113.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,021.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$727.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: Networks By Design Commercial |
$1,970.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,576.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,818.60
|
| 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 |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
IP
|
$3,031.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$727.44 |
| Max. Negotiated Rate |
$2,576.35 |
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,212.40
|
| Rate for Payer: Galaxy Health WC |
$2,576.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,818.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,021.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,154.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$727.44
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: Networks By Design Commercial |
$1,970.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,576.35
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$386.75 |
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$273.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: Dignity Health Media |
$386.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$341.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$364.00
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| 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 |
$386.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
|
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$6,597.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,622.40
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,778.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,848.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$6,163.20
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
