|
HC SINUS/ PARANASAL COMPLETE
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
909001141
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$1,211.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$169.91
|
| 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 |
$205.46
|
| Rate for Payer: Blue Distinction Transplant |
$855.00
|
| Rate for Payer: Blue Shield of California Commercial |
$842.18
|
| Rate for Payer: Blue Shield of California EPN |
$668.32
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cigna of CA HMO |
$912.00
|
| Rate for Payer: Cigna of CA PPO |
$1,054.50
|
| 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 |
$1,211.25
|
| Rate for Payer: Global Benefits Group Commercial |
$855.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,068.75
|
| 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 |
$950.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$342.00
|
| 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 |
$1,140.00
|
| Rate for Payer: Networks By Design Commercial |
$926.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,211.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$855.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$855.00
|
| 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 SIROLIMUS
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
900912167
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.12 |
| Max. Negotiated Rate |
$122.48 |
| Rate for Payer: Aetna of CA HMO/PPO |
$114.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.48
|
| Rate for Payer: Blue Distinction Transplant |
$31.80
|
| Rate for Payer: Blue Shield of California Commercial |
$34.24
|
| Rate for Payer: Blue Shield of California EPN |
$27.14
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cash Price |
$23.85
|
| Rate for Payer: Cigna of CA HMO |
$33.92
|
| Rate for Payer: Cigna of CA PPO |
$39.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.60
|
| Rate for Payer: Dignity Health Media |
$13.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.54
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.73
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.73
|
| Rate for Payer: Galaxy Health WC |
$45.05
|
| Rate for Payer: Global Benefits Group Commercial |
$31.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.52
|
| Rate for Payer: Heritage Provider Network Transplant |
$22.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$22.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Networks By Design Commercial |
$34.45
|
| Rate for Payer: Prime Health Services Commercial |
$45.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.12
|
| Rate for Payer: United Healthcare All Other HMO |
$11.12
|
| Rate for Payer: United Healthcare HMO Rider |
$11.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.10
|
| Rate for Payer: Vantage Medical Group Senior |
$13.73
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
OP
|
$6,484.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$719.27 |
| Max. Negotiated Rate |
$10,539.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$719.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,511.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,566.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,566.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,539.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,890.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$2,917.80
|
| Rate for Payer: Cash Price |
$2,917.80
|
| Rate for Payer: Cash Price |
$2,917.80
|
| Rate for Payer: Cigna of CA PPO |
$4,798.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,511.40
|
| Rate for Payer: Dignity Health Media |
$5,511.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,511.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,593.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,593.60
|
| Rate for Payer: Galaxy Health WC |
$5,511.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,890.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,863.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,470.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,556.16
|
| Rate for Payer: Multiplan Commercial |
$5,187.20
|
| Rate for Payer: Networks By Design Commercial |
$4,214.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,511.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,890.40
|
| 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 |
$5,511.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,511.40
|
| Rate for Payer: Vantage Medical Group Senior |
$5,511.40
|
|
|
HC S & I STENT/CHEST VERT ART EA
|
Facility
|
IP
|
$6,484.00
|
|
|
Service Code
|
CPT 0076T
|
| Hospital Charge Code |
909081391
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,556.16 |
| Max. Negotiated Rate |
$5,511.40 |
| Rate for Payer: Cash Price |
$2,917.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,593.60
|
| Rate for Payer: Galaxy Health WC |
$5,511.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,890.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,324.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,470.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,556.16
|
| Rate for Payer: Multiplan Commercial |
$5,187.20
|
| Rate for Payer: Networks By Design Commercial |
$4,214.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,511.40
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
OP
|
$1,279.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$306.96 |
| Max. Negotiated Rate |
$3,618.67 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,135.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$703.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$703.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,618.67
|
| Rate for Payer: Blue Distinction Transplant |
$767.40
|
| Rate for Payer: Blue Shield of California Commercial |
$755.89
|
| Rate for Payer: Blue Shield of California EPN |
$599.85
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: Cigna of CA HMO |
$818.56
|
| Rate for Payer: Cigna of CA PPO |
$946.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Dignity Health Media |
$1,087.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,087.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$959.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.96
|
| Rate for Payer: Multiplan Commercial |
$1,023.20
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$767.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$767.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$639.50
|
| Rate for Payer: United Healthcare All Other HMO |
$639.50
|
| Rate for Payer: United Healthcare HMO Rider |
$639.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$639.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,087.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,087.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,087.15
|
|
|
HC S&I STENT COARCT INCL LSCA
|
Facility
|
IP
|
$1,279.00
|
|
|
Service Code
|
CPT 75956
|
| Hospital Charge Code |
906811484
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$306.96 |
| Max. Negotiated Rate |
$1,087.15 |
| Rate for Payer: Cash Price |
$575.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$511.60
|
| Rate for Payer: Galaxy Health WC |
$1,087.15
|
| Rate for Payer: Global Benefits Group Commercial |
$767.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$853.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$487.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.96
|
| Rate for Payer: Multiplan Commercial |
$1,023.20
|
| Rate for Payer: Networks By Design Commercial |
$831.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,087.15
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.04 |
| Max. Negotiated Rate |
$931.60 |
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC S&I STENT COARCT NOT INCL LSCA
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 75957
|
| Hospital Charge Code |
906811486
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.04 |
| Max. Negotiated Rate |
$3,100.19 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,828.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$931.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$602.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,100.19
|
| Rate for Payer: Blue Distinction Transplant |
$657.60
|
| Rate for Payer: Blue Shield of California Commercial |
$647.74
|
| Rate for Payer: Blue Shield of California EPN |
$514.02
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna of CA HMO |
$701.44
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$931.60
|
| Rate for Payer: Dignity Health Media |
$931.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$931.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$822.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$931.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$931.60
|
| Rate for Payer: Vantage Medical Group Senior |
$931.60
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
IP
|
$2,722.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$653.28 |
| Max. Negotiated Rate |
$2,313.70 |
| Rate for Payer: Cash Price |
$1,224.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,088.80
|
| Rate for Payer: Galaxy Health WC |
$2,313.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,633.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,815.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,037.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.28
|
| Rate for Payer: Multiplan Commercial |
$2,177.60
|
| Rate for Payer: Networks By Design Commercial |
$1,769.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,313.70
|
|
|
HC SKIN SUB GRFT DIGIT 1ST 25 SQ
|
Facility
|
OP
|
$2,722.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
900501784
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.87 |
| 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 |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,633.20
|
| Rate for Payer: Cash Price |
$1,224.90
|
| Rate for Payer: Cash Price |
$1,224.90
|
| Rate for Payer: Cash Price |
$1,224.90
|
| Rate for Payer: Cigna of CA PPO |
$2,014.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$2,313.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,633.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,041.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,815.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$2,177.60
|
| Rate for Payer: Networks By Design Commercial |
$1,769.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,313.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,633.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,361.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,361.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,361.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,361.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC SKULL COMPLETE
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.42 |
| Max. Negotiated Rate |
$1,102.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$195.91
|
| 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 |
$234.46
|
| Rate for Payer: Blue Distinction Transplant |
$778.20
|
| Rate for Payer: Blue Shield of California Commercial |
$766.53
|
| Rate for Payer: Blue Shield of California EPN |
$608.29
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Cigna of CA HMO |
$830.08
|
| Rate for Payer: Cigna of CA PPO |
$959.78
|
| 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 |
$1,102.45
|
| Rate for Payer: Global Benefits Group Commercial |
$778.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$972.75
|
| 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 |
$865.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.28
|
| 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 |
$1,037.60
|
| Rate for Payer: Networks By Design Commercial |
$843.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,102.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$778.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$778.20
|
| 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 SKULL COMPLETE
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
909001143
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$311.28 |
| Max. Negotiated Rate |
$1,102.45 |
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.80
|
| Rate for Payer: Galaxy Health WC |
$1,102.45
|
| Rate for Payer: Global Benefits Group Commercial |
$778.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$865.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$494.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.28
|
| Rate for Payer: Multiplan Commercial |
$1,037.60
|
| Rate for Payer: Networks By Design Commercial |
$843.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,102.45
|
|
|
HC SKULL LIMITED
|
Facility
|
IP
|
$971.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$233.04 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.40
|
| Rate for Payer: Galaxy Health WC |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.04
|
| Rate for Payer: Multiplan Commercial |
$776.80
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
|
|
HC SKULL LIMITED
|
Facility
|
OP
|
$971.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
909001144
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$825.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$159.07
|
| 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 |
$162.28
|
| Rate for Payer: Blue Distinction Transplant |
$582.60
|
| Rate for Payer: Blue Shield of California Commercial |
$573.86
|
| Rate for Payer: Blue Shield of California EPN |
$455.40
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cash Price |
$436.95
|
| Rate for Payer: Cigna of CA HMO |
$621.44
|
| Rate for Payer: Cigna of CA PPO |
$718.54
|
| 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 |
$825.35
|
| Rate for Payer: Global Benefits Group Commercial |
$582.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$728.25
|
| 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 |
$647.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$233.04
|
| 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 |
$776.80
|
| Rate for Payer: Networks By Design Commercial |
$631.15
|
| Rate for Payer: Prime Health Services Commercial |
$825.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$582.60
|
| 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 SLEEP STUDY 4 CHANNEL
|
Facility
|
OP
|
$4,014.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
903600038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$401.45 |
| Max. Negotiated Rate |
$6,702.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,792.56
|
| 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 |
$2,391.54
|
| Rate for Payer: Blue Distinction Transplant |
$2,408.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,372.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,882.57
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: Cigna of CA HMO |
$2,568.96
|
| Rate for Payer: Cigna of CA PPO |
$2,970.36
|
| 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 |
$3,411.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,408.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,010.50
|
| 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 |
$2,677.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$963.36
|
| 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 |
$3,211.20
|
| Rate for Payer: Networks By Design Commercial |
$2,609.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,411.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,408.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,408.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,702.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,698.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,497.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,113.00
|
| 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 SLEEP STUDY 4 CHANNEL
|
Facility
|
IP
|
$4,014.00
|
|
|
Service Code
|
CPT 95807
|
| Hospital Charge Code |
903600038
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$963.36 |
| Max. Negotiated Rate |
$3,411.90 |
| Rate for Payer: Cash Price |
$1,806.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,605.60
|
| Rate for Payer: Galaxy Health WC |
$3,411.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,408.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,677.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,529.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$963.36
|
| Rate for Payer: Multiplan Commercial |
$3,211.20
|
| Rate for Payer: Networks By Design Commercial |
$2,609.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,411.90
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$162.72 |
| Max. Negotiated Rate |
$576.30 |
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.20
|
| Rate for Payer: Galaxy Health WC |
$576.30
|
| Rate for Payer: Global Benefits Group Commercial |
$406.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$452.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.72
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: Networks By Design Commercial |
$440.70
|
| Rate for Payer: Prime Health Services Commercial |
$576.30
|
|
|
HC SLIDE PREP/REFERRED MATERIAL
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 88323
|
| Hospital Charge Code |
903800072
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$40.08 |
| Max. Negotiated Rate |
$373.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$373.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.75
|
| Rate for Payer: Blue Distinction Transplant |
$100.20
|
| Rate for Payer: Blue Shield of California Commercial |
$107.88
|
| Rate for Payer: Blue Shield of California EPN |
$85.50
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cash Price |
$75.15
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$125.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$111.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$109.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$85.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
OP
|
$8,572.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$257.49 |
| 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 |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,143.20
|
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Cigna of CA PPO |
$6,343.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$7,286.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,143.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,429.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,173.59
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,717.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,057.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,206.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$6,857.60
|
| Rate for Payer: Networks By Design Commercial |
$5,571.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,286.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,143.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,286.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,286.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,286.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,286.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
IP
|
$8,572.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,057.28 |
| Max. Negotiated Rate |
$7,286.20 |
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,428.80
|
| Rate for Payer: Galaxy Health WC |
$7,286.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,143.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,717.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,265.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,057.28
|
| Rate for Payer: Multiplan Commercial |
$6,857.60
|
| Rate for Payer: Networks By Design Commercial |
$5,571.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,286.20
|
|
|
HC SLOW ACTIVATION
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$54.79 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.79
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$14.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.26
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Media |
$6.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.86
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
OP
|
$24,959.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$5,990.16 |
| Max. Negotiated Rate |
$112,749.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$112,749.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,889.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,985.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,259.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,992.21
|
| Rate for Payer: Blue Distinction Transplant |
$14,975.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14,750.77
|
| Rate for Payer: Blue Shield of California EPN |
$11,705.77
|
| Rate for Payer: Cash Price |
$11,231.55
|
| Rate for Payer: Cash Price |
$11,231.55
|
| Rate for Payer: Cigna of CA HMO |
$15,973.76
|
| Rate for Payer: Cigna of CA PPO |
$18,469.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,889.78
|
| Rate for Payer: Dignity Health Media |
$17,259.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,985.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,300.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17,259.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$17,259.85
|
| Rate for Payer: Galaxy Health WC |
$21,215.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14,975.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18,719.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$28,306.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$28,306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27,960.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$27,960.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,259.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,647.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,945.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,259.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,990.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21,747.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,128.20
|
| Rate for Payer: Multiplan Commercial |
$19,967.20
|
| Rate for Payer: Networks By Design Commercial |
$16,223.35
|
| Rate for Payer: Prime Health Services Commercial |
$21,215.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,975.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14,975.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,479.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12,479.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,479.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,889.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,985.84
|
| Rate for Payer: Vantage Medical Group Senior |
$17,259.85
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
IP
|
$24,959.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$5,990.16 |
| Max. Negotiated Rate |
$21,215.15 |
| Rate for Payer: Blue Shield of California Commercial |
$17,770.81
|
| Rate for Payer: Blue Shield of California EPN |
$12,779.01
|
| Rate for Payer: Cash Price |
$11,231.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,983.60
|
| Rate for Payer: Galaxy Health WC |
$21,215.15
|
| Rate for Payer: Global Benefits Group Commercial |
$14,975.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,647.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,509.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,990.16
|
| Rate for Payer: Multiplan Commercial |
$19,967.20
|
| Rate for Payer: Networks By Design Commercial |
$16,223.35
|
| Rate for Payer: Prime Health Services Commercial |
$21,215.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,424.52
|
| Rate for Payer: United Healthcare All Other HMO |
$9,204.88
|
| Rate for Payer: United Healthcare HMO Rider |
$9,005.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,236.47
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
IP
|
$1,857.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$445.68 |
| Max. Negotiated Rate |
$1,578.45 |
| Rate for Payer: Cash Price |
$835.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$742.80
|
| Rate for Payer: Galaxy Health WC |
$1,578.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,238.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$707.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.68
|
| Rate for Payer: Multiplan Commercial |
$1,485.60
|
| Rate for Payer: Networks By Design Commercial |
$1,207.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.45
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
OP
|
$1,857.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.78 |
| Max. Negotiated Rate |
$1,578.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$531.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.17
|
| Rate for Payer: Blue Distinction Transplant |
$1,114.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,097.49
|
| Rate for Payer: Blue Shield of California EPN |
$870.93
|
| Rate for Payer: Cash Price |
$835.65
|
| Rate for Payer: Cash Price |
$835.65
|
| Rate for Payer: Cigna of CA HMO |
$1,188.48
|
| Rate for Payer: Cigna of CA PPO |
$1,374.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,578.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,114.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,392.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,238.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$445.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,485.60
|
| Rate for Payer: Networks By Design Commercial |
$1,207.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,578.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,114.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,114.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
