|
HC SYNERCID E TEST
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912447
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$20.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.58
|
| Rate for Payer: Blue Distinction Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.46
|
| Rate for Payer: Blue Shield of California EPN |
$5.12
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Media |
$4.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.36
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SYPHILIS NON TREP QUAL RPR
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900913673
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$38.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.94
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILIS NON TREP QUANT
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
900913672
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$40.17 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.17
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.60
|
| Rate for Payer: Dignity Health Media |
$4.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.40
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.22
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$7.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.84
|
| Rate for Payer: Vantage Medical Group Senior |
$4.40
|
|
|
HC SYPHILIS TOTAL
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913674
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$213.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.45
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Media |
$11.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$11.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$18.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC SYPHILLIS IGG
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
900913561
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.24 |
| Max. Negotiated Rate |
$158.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$110.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.29
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.80
|
| Rate for Payer: Blue Shield of California EPN |
$13.31
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.86
|
| Rate for Payer: Dignity Health Media |
$13.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.24
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.24
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.71
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$21.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$21.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.73
|
| Rate for Payer: United Healthcare All Other HMO |
$10.73
|
| Rate for Payer: United Healthcare HMO Rider |
$10.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.56
|
| Rate for Payer: Vantage Medical Group Senior |
$13.24
|
|
|
HC SYPHILLIS TEST RPR
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910892
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$38.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.94
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILLIS TEST RPR INDIVIDUAL
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900912331
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$38.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.94
|
| Rate for Payer: Blue Distinction Transplant |
$7.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7.75
|
| Rate for Payer: Blue Shield of California EPN |
$6.14
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna of CA HMO |
$7.68
|
| Rate for Payer: Cigna of CA PPO |
$8.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$10.20
|
| Rate for Payer: Global Benefits Group Commercial |
$7.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Networks By Design Commercial |
$7.80
|
| Rate for Payer: Prime Health Services Commercial |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC SYPHILLIS TEST VDRL/ CSF
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
900910861
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$38.94 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.94
|
| Rate for Payer: Blue Distinction Transplant |
$10.20
|
| Rate for Payer: Blue Shield of California Commercial |
$10.98
|
| Rate for Payer: Blue Shield of California EPN |
$8.70
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cash Price |
$7.65
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.40
|
| Rate for Payer: Dignity Health Media |
$4.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Heritage Provider Network Transplant |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC TANGNTL BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
900511103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.48 |
| 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 |
$277.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$179.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$179.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$196.20
|
| 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 |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: Cigna of CA PPO |
$241.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.95
|
| Rate for Payer: Dignity Health Media |
$277.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$245.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.20
|
| 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 |
$277.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.95
|
| Rate for Payer: Vantage Medical Group Senior |
$277.95
|
|
|
HC TANGNTL BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
900511103
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$277.95 |
| Rate for Payer: Cash Price |
$147.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$130.80
|
| Rate for Payer: Galaxy Health WC |
$277.95
|
| Rate for Payer: Global Benefits Group Commercial |
$196.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$218.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.48
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Networks By Design Commercial |
$212.55
|
| Rate for Payer: Prime Health Services Commercial |
$277.95
|
|
|
HC TANGNTL BX SKIN SINGLE LESION
|
Facility
|
OP
|
$653.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
900511102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.72 |
| 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 |
$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 |
$391.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,612.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,351.09
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: Cigna of CA PPO |
$483.22
|
| 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 |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$489.75
|
| 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 |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$405.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| 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 |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$424.45
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.80
|
| 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 |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC TANGNTL BX SKIN SINGLE LESION
|
Facility
|
IP
|
$653.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
900511102
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.72 |
| Max. Negotiated Rate |
$555.05 |
| Rate for Payer: Cash Price |
$293.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.20
|
| Rate for Payer: Galaxy Health WC |
$555.05
|
| Rate for Payer: Global Benefits Group Commercial |
$391.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$435.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.72
|
| Rate for Payer: Multiplan Commercial |
$522.40
|
| Rate for Payer: Networks By Design Commercial |
$424.45
|
| Rate for Payer: Prime Health Services Commercial |
$555.05
|
|
|
HC TARSORRHAPHY
|
Facility
|
OP
|
$4,884.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
900501730
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.06 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,930.40
|
| Rate for Payer: Cash Price |
$2,197.80
|
| Rate for Payer: Cash Price |
$2,197.80
|
| Rate for Payer: Cash Price |
$2,197.80
|
| Rate for Payer: Cigna of CA PPO |
$3,614.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$4,151.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,930.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,663.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| 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 |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,257.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$3,907.20
|
| Rate for Payer: Networks By Design Commercial |
$3,174.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,151.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,930.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,442.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,442.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,442.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,442.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC TARSORRHAPHY
|
Facility
|
IP
|
$4,884.00
|
|
|
Service Code
|
CPT 67880
|
| Hospital Charge Code |
900501730
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,172.16 |
| Max. Negotiated Rate |
$4,151.40 |
| Rate for Payer: Cash Price |
$2,197.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,953.60
|
| Rate for Payer: Galaxy Health WC |
$4,151.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,930.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,257.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,860.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,172.16
|
| Rate for Payer: Multiplan Commercial |
$3,907.20
|
| Rate for Payer: Networks By Design Commercial |
$3,174.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,151.40
|
|
|
HC TAVI TAVR
|
Facility
|
IP
|
$136,000.00
|
|
| Hospital Charge Code |
906811453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$32,640.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$61,200.00
|
| Rate for Payer: Cash Price |
$61,200.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,400.00
|
| Rate for Payer: Galaxy Health WC |
$115,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$81,600.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90,712.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51,816.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32,640.00
|
| Rate for Payer: Multiplan Commercial |
$108,800.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$115,600.00
|
|
|
HC TAVI TAVR
|
Facility
|
OP
|
$136,000.00
|
|
| Hospital Charge Code |
906811453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$115,600.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$89,202.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$115,600.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74,800.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74,800.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81,028.80
|
| Rate for Payer: Blue Distinction Transplant |
$81,600.00
|
| 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 |
$61,200.00
|
| Rate for Payer: Cash Price |
$61,200.00
|
| Rate for Payer: Cigna of CA PPO |
$100,640.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$115,600.00
|
| Rate for Payer: Dignity Health Media |
$115,600.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$115,600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$54,400.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$54,400.00
|
| Rate for Payer: Galaxy Health WC |
$115,600.00
|
| Rate for Payer: Global Benefits Group Commercial |
$81,600.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$102,000.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90,712.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51,816.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32,640.00
|
| Rate for Payer: Multiplan Commercial |
$108,800.00
|
| Rate for Payer: Networks By Design Commercial |
$88,400.00
|
| Rate for Payer: Prime Health Services Commercial |
$115,600.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81,600.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$68,000.00
|
| Rate for Payer: United Healthcare All Other HMO |
$68,000.00
|
| Rate for Payer: United Healthcare HMO Rider |
$68,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$115,600.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$115,600.00
|
| Rate for Payer: Vantage Medical Group Senior |
$115,600.00
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
IP
|
$63,684.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906820339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$15,284.16 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,473.60
|
| Rate for Payer: Galaxy Health WC |
$54,131.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,210.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42,477.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24,263.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,284.16
|
| Rate for Payer: Multiplan Commercial |
$50,947.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$54,131.40
|
|
|
HC TAVR W PROS VALVE OPN ILIAC
|
Facility
|
OP
|
$63,684.00
|
|
|
Service Code
|
CPT 33364
|
| Hospital Charge Code |
906820339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,257.00 |
| Max. Negotiated Rate |
$54,131.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,468.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54,131.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35,026.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,026.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$38,210.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Cash Price |
$28,657.80
|
| Rate for Payer: Cigna of CA PPO |
$47,126.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54,131.40
|
| Rate for Payer: Dignity Health Media |
$54,131.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$54,131.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$25,473.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$25,473.60
|
| Rate for Payer: Galaxy Health WC |
$54,131.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38,210.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47,763.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42,477.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,474.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,284.16
|
| Rate for Payer: Multiplan Commercial |
$50,947.20
|
| Rate for Payer: Networks By Design Commercial |
$41,394.60
|
| Rate for Payer: Prime Health Services Commercial |
$54,131.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38,210.40
|
| 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 |
$54,131.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54,131.40
|
| Rate for Payer: Vantage Medical Group Senior |
$54,131.40
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
OP
|
$67,098.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906820340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$539.01 |
| Max. Negotiated Rate |
$57,033.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10,317.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57,033.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36,903.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36,903.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,375.00
|
| Rate for Payer: Blue Distinction Transplant |
$40,258.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,058.23
|
| Rate for Payer: Blue Shield of California EPN |
$5,244.75
|
| Rate for Payer: Cash Price |
$30,194.10
|
| Rate for Payer: Cash Price |
$30,194.10
|
| Rate for Payer: Cigna of CA PPO |
$49,652.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57,033.30
|
| Rate for Payer: Dignity Health Media |
$57,033.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$57,033.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,839.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$26,839.20
|
| Rate for Payer: Galaxy Health WC |
$57,033.30
|
| Rate for Payer: Global Benefits Group Commercial |
$40,258.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$50,323.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44,754.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$539.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,103.52
|
| Rate for Payer: Multiplan Commercial |
$53,678.40
|
| Rate for Payer: Networks By Design Commercial |
$43,613.70
|
| Rate for Payer: Prime Health Services Commercial |
$57,033.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40,258.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57,033.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57,033.30
|
| Rate for Payer: Vantage Medical Group Senior |
$57,033.30
|
|
|
HC TAVR W PROS VALVE TRNSAORTIC
|
Facility
|
IP
|
$67,098.00
|
|
|
Service Code
|
CPT 33365
|
| Hospital Charge Code |
906820340
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$16,103.52 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$30,194.10
|
| Rate for Payer: Cash Price |
$30,194.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$26,839.20
|
| Rate for Payer: Galaxy Health WC |
$57,033.30
|
| Rate for Payer: Global Benefits Group Commercial |
$40,258.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44,754.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25,564.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16,103.52
|
| Rate for Payer: Multiplan Commercial |
$53,678.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$57,033.30
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
IP
|
$61,488.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906820341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$14,757.12 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$27,669.60
|
| Rate for Payer: Cash Price |
$27,669.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,595.20
|
| Rate for Payer: Galaxy Health WC |
$52,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$36,892.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41,012.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23,426.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,757.12
|
| Rate for Payer: Multiplan Commercial |
$49,190.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$52,264.80
|
|
|
HC TAVR W PROS VALVE TRNSAPICAL
|
Facility
|
OP
|
$61,488.00
|
|
|
Service Code
|
CPT 33366
|
| Hospital Charge Code |
906820341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$542.56 |
| Max. Negotiated Rate |
$52,264.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11,638.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52,264.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33,818.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33,818.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,539.00
|
| Rate for Payer: Blue Distinction Transplant |
$36,892.80
|
| Rate for Payer: Blue Shield of California Commercial |
$833.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.56
|
| Rate for Payer: Cash Price |
$27,669.60
|
| Rate for Payer: Cash Price |
$27,669.60
|
| Rate for Payer: Cigna of CA PPO |
$45,501.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52,264.80
|
| Rate for Payer: Dignity Health Media |
$52,264.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$52,264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,595.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$24,595.20
|
| Rate for Payer: Galaxy Health WC |
$52,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$36,892.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$46,116.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41,012.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,053.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14,757.12
|
| Rate for Payer: Multiplan Commercial |
$49,190.40
|
| Rate for Payer: Networks By Design Commercial |
$39,967.20
|
| Rate for Payer: Prime Health Services Commercial |
$52,264.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36,892.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52,264.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52,264.80
|
| Rate for Payer: Vantage Medical Group Senior |
$52,264.80
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
941000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.38 |
| Max. Negotiated Rate |
$64.93 |
| Rate for Payer: Aetna of CA HMO/PPO |
$46.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.93
|
| Rate for Payer: Blue Distinction Transplant |
$36.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38.76
|
| Rate for Payer: Blue Shield of California EPN |
$30.72
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Media |
$37.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$60.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC TB INTRADERMAL TEST
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
941000516
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$51.00 |
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC TCATH RMVL OR DBLK ICAR MASS OR VEG
|
Facility
|
IP
|
$14,072.00
|
|
|
Service Code
|
CPT 0644T
|
| Hospital Charge Code |
906811644
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,377.28 |
| Max. Negotiated Rate |
$11,961.20 |
| Rate for Payer: Cash Price |
$6,332.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,628.80
|
| Rate for Payer: Galaxy Health WC |
$11,961.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,443.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,386.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,361.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,377.28
|
| Rate for Payer: Multiplan Commercial |
$11,257.60
|
| Rate for Payer: Networks By Design Commercial |
$9,146.80
|
| Rate for Payer: Prime Health Services Commercial |
$11,961.20
|
|
