|
HC TISSUE HOMOGENIZATION, CULTR
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 87176
|
| Hospital Charge Code |
900911804
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$53.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.68
|
| 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 |
$8.82
|
| Rate for Payer: Dignity Health Media |
$5.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.88
|
| 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 |
$9.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.88
|
| 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 |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$5.88
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
OP
|
$958.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.04 |
| Max. Negotiated Rate |
$814.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$159.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.94
|
| Rate for Payer: Blue Distinction Transplant |
$574.80
|
| Rate for Payer: Blue Shield of California Commercial |
$566.18
|
| Rate for Payer: Blue Shield of California EPN |
$449.30
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: Cigna of CA HMO |
$613.12
|
| Rate for Payer: Cigna of CA PPO |
$708.92
|
| 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 |
$814.30
|
| Rate for Payer: Global Benefits Group Commercial |
$574.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$718.50
|
| 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 |
$638.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.92
|
| 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 |
$766.40
|
| Rate for Payer: Networks By Design Commercial |
$622.70
|
| Rate for Payer: Prime Health Services Commercial |
$814.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$574.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$574.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC T & L JUNCTION AP AND LATERAL
|
Facility
|
IP
|
$958.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
909001312
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.92 |
| Max. Negotiated Rate |
$814.30 |
| Rate for Payer: Cash Price |
$431.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$383.20
|
| Rate for Payer: Galaxy Health WC |
$814.30
|
| Rate for Payer: Global Benefits Group Commercial |
$574.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$638.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$365.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.92
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: Networks By Design Commercial |
$622.70
|
| Rate for Payer: Prime Health Services Commercial |
$814.30
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$317.90 |
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.76
|
| Rate for Payer: Multiplan Commercial |
$299.20
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC TMJ ARTHROGRAPHY INJECTION
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 21116
|
| Hospital Charge Code |
909000112
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.76 |
| 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 |
$317.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$224.40
|
| 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 |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.90
|
| Rate for Payer: Dignity Health Media |
$317.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$280.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.76
|
| Rate for Payer: Multiplan Commercial |
$299.20
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.90
|
| Rate for Payer: Vantage Medical Group Senior |
$317.90
|
|
|
HC TMJ OPEN CLOSE UNILATERAL
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.46 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$139.60
|
| 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 |
$128.74
|
| Rate for Payer: Blue Distinction Transplant |
$476.40
|
| Rate for Payer: Blue Shield of California Commercial |
$469.25
|
| Rate for Payer: Blue Shield of California EPN |
$372.39
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: Cigna of CA HMO |
$508.16
|
| Rate for Payer: Cigna of CA PPO |
$587.56
|
| 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 |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$595.50
|
| 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 |
$529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| 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 |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$476.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$476.40
|
| 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 TMJ OPEN CLOSE UNILATERAL
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 70328
|
| Hospital Charge Code |
909001164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.56 |
| Max. Negotiated Rate |
$674.90 |
| Rate for Payer: Cash Price |
$357.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$317.60
|
| Rate for Payer: Galaxy Health WC |
$674.90
|
| Rate for Payer: Global Benefits Group Commercial |
$476.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$529.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.56
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Networks By Design Commercial |
$516.10
|
| Rate for Payer: Prime Health Services Commercial |
$674.90
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
OP
|
$1,536.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$364.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$548.64
|
| Rate for Payer: Blue Distinction Transplant |
$921.60
|
| Rate for Payer: Blue Shield of California Commercial |
$907.78
|
| Rate for Payer: Blue Shield of California EPN |
$720.38
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Cigna of CA HMO |
$983.04
|
| Rate for Payer: Cigna of CA PPO |
$1,136.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,152.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$495.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$129.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$921.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$921.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.29
|
| Rate for Payer: United Healthcare All Other HMO |
$718.29
|
| Rate for Payer: United Healthcare HMO Rider |
$718.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$718.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC TM JT ARTHROGRAM
|
Facility
|
IP
|
$1,536.00
|
|
|
Service Code
|
CPT 70332
|
| Hospital Charge Code |
909001166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.64 |
| Max. Negotiated Rate |
$1,305.60 |
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,024.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$585.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.64
|
| Rate for Payer: Multiplan Commercial |
$1,228.80
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
|
|
HC TOBRAMYCIN
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 80200
|
| Hospital Charge Code |
900910408
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$147.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$134.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.05
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$32.30
|
| Rate for Payer: Blue Shield of California EPN |
$25.60
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.20
|
| Rate for Payer: Dignity Health Media |
$16.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.78
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.13
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$26.45
|
| Rate for Payer: Heritage Provider Network Transplant |
$26.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$26.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.61
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.07
|
| Rate for Payer: United Healthcare All Other HMO |
$13.07
|
| Rate for Payer: United Healthcare HMO Rider |
$13.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.74
|
| Rate for Payer: Vantage Medical Group Senior |
$16.13
|
|
|
HC TOES
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.88 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.80
|
| Rate for Payer: Galaxy Health WC |
$520.20
|
| Rate for Payer: Global Benefits Group Commercial |
$367.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$408.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.88
|
| Rate for Payer: Multiplan Commercial |
$489.60
|
| Rate for Payer: Networks By Design Commercial |
$397.80
|
| Rate for Payer: Prime Health Services Commercial |
$520.20
|
|
|
HC TOES
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
909001634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.62 |
| Max. Negotiated Rate |
$520.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$146.14
|
| 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 |
$110.13
|
| Rate for Payer: Blue Distinction Transplant |
$367.20
|
| Rate for Payer: Blue Shield of California Commercial |
$361.69
|
| Rate for Payer: Blue Shield of California EPN |
$287.03
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna of CA HMO |
$391.68
|
| Rate for Payer: Cigna of CA PPO |
$452.88
|
| 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 |
$520.20
|
| Rate for Payer: Global Benefits Group Commercial |
$367.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$459.00
|
| 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 |
$408.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$146.88
|
| 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 |
$489.60
|
| Rate for Payer: Networks By Design Commercial |
$397.80
|
| Rate for Payer: Prime Health Services Commercial |
$520.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$367.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$367.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.51 |
| Max. Negotiated Rate |
$679.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$481.58
|
| 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 |
$328.25
|
| Rate for Payer: Blue Distinction Transplant |
$479.40
|
| Rate for Payer: Blue Shield of California Commercial |
$472.21
|
| Rate for Payer: Blue Shield of California EPN |
$374.73
|
| Rate for Payer: Cash Price |
$359.55
|
| Rate for Payer: Cash Price |
$359.55
|
| Rate for Payer: Cigna of CA HMO |
$511.36
|
| Rate for Payer: Cigna of CA PPO |
$591.26
|
| 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 |
$679.15
|
| Rate for Payer: Global Benefits Group Commercial |
$479.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$599.25
|
| 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 |
$532.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.76
|
| 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 |
$639.20
|
| Rate for Payer: Networks By Design Commercial |
$519.35
|
| Rate for Payer: Prime Health Services Commercial |
$679.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$479.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$479.40
|
| 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 TOMOGRAPHY SINGLE PLANE BODY SEC
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
CPT 76100
|
| Hospital Charge Code |
909001551
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.76 |
| Max. Negotiated Rate |
$679.15 |
| Rate for Payer: Cash Price |
$359.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$319.60
|
| Rate for Payer: Galaxy Health WC |
$679.15
|
| Rate for Payer: Global Benefits Group Commercial |
$479.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$532.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$304.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.76
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: Networks By Design Commercial |
$519.35
|
| Rate for Payer: Prime Health Services Commercial |
$679.15
|
|
|
HC TOTAL BODY THYROID SCAN
|
Facility
|
IP
|
$4,925.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
909301317
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,182.00 |
| Max. Negotiated Rate |
$4,186.25 |
| Rate for Payer: Cash Price |
$2,216.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,970.00
|
| Rate for Payer: Galaxy Health WC |
$4,186.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,955.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,284.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,876.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.00
|
| Rate for Payer: Multiplan Commercial |
$3,940.00
|
| Rate for Payer: Networks By Design Commercial |
$3,201.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,186.25
|
|
|
HC TOTAL BODY THYROID SCAN
|
Facility
|
OP
|
$4,925.00
|
|
|
Service Code
|
CPT 78018
|
| Hospital Charge Code |
909301317
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$246.62 |
| Max. Negotiated Rate |
$4,186.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,760.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,934.32
|
| Rate for Payer: Blue Distinction Transplant |
$2,955.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,910.68
|
| Rate for Payer: Blue Shield of California EPN |
$2,309.82
|
| Rate for Payer: Cash Price |
$2,216.25
|
| Rate for Payer: Cash Price |
$2,216.25
|
| Rate for Payer: Cigna of CA HMO |
$3,152.00
|
| Rate for Payer: Cigna of CA PPO |
$3,644.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$4,186.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,955.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,693.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,284.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,182.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$3,940.00
|
| Rate for Payer: Networks By Design Commercial |
$3,201.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,186.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,955.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,955.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$717.15
|
| Rate for Payer: United Healthcare All Other HMO |
$717.15
|
| Rate for Payer: United Healthcare HMO Rider |
$717.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$717.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC TOTAL LUNG LAVAGE UNILATERAL
|
Facility
|
OP
|
$1,625.00
|
|
|
Service Code
|
CPT 32997
|
| Hospital Charge Code |
900803550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,050.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,381.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$893.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$975.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,197.62
|
| Rate for Payer: Blue Shield of California EPN |
$949.00
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: Cigna of CA HMO |
$1,040.00
|
| Rate for Payer: Cigna of CA PPO |
$1,202.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,381.25
|
| Rate for Payer: Dignity Health Media |
$1,381.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,381.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$650.00
|
| Rate for Payer: Galaxy Health WC |
$1,381.25
|
| Rate for Payer: Global Benefits Group Commercial |
$975.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,218.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.00
|
| Rate for Payer: Multiplan Commercial |
$1,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,056.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,381.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$975.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$975.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$812.50
|
| Rate for Payer: United Healthcare All Other HMO |
$812.50
|
| Rate for Payer: United Healthcare HMO Rider |
$812.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$812.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,381.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,381.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,381.25
|
|
|
HC TOTAL LUNG LAVAGE UNILATERAL
|
Facility
|
IP
|
$1,625.00
|
|
|
Service Code
|
CPT 32997
|
| Hospital Charge Code |
900803550
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$390.00 |
| Max. Negotiated Rate |
$1,381.25 |
| Rate for Payer: Cash Price |
$731.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$650.00
|
| Rate for Payer: Galaxy Health WC |
$1,381.25
|
| Rate for Payer: Global Benefits Group Commercial |
$975.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,083.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$619.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.00
|
| Rate for Payer: Multiplan Commercial |
$1,300.00
|
| Rate for Payer: Networks By Design Commercial |
$1,056.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,381.25
|
|
|
HC TOXOPLASMA AB IGG
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900910989
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.66 |
| Max. Negotiated Rate |
$130.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.89
|
| Rate for Payer: Blue Distinction Transplant |
$33.00
|
| Rate for Payer: Blue Shield of California Commercial |
$35.53
|
| Rate for Payer: Blue Shield of California EPN |
$28.16
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Media |
$14.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC TOXOPLASMA AB IGM
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900912320
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$11.67 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.87
|
| Rate for Payer: Blue Distinction Transplant |
$33.00
|
| Rate for Payer: Blue Shield of California Commercial |
$35.53
|
| Rate for Payer: Blue Shield of California EPN |
$28.16
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: Dignity Health Media |
$14.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$41.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.63
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC TOXOPLASMA ANTIBODY IGG
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
900913667
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$130.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.89
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.58
|
| Rate for Payer: Dignity Health Media |
$14.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.39
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.60
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.28
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.66
|
| Rate for Payer: United Healthcare All Other HMO |
$11.66
|
| Rate for Payer: United Healthcare HMO Rider |
$11.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.83
|
| Rate for Payer: Vantage Medical Group Senior |
$14.39
|
|
|
HC TOXOPLASMA ANTIBODY IGM
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
900913668
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.87
|
| Rate for Payer: Blue Distinction Transplant |
$23.40
|
| Rate for Payer: Blue Shield of California Commercial |
$25.19
|
| Rate for Payer: Blue Shield of California EPN |
$19.97
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.62
|
| Rate for Payer: Dignity Health Media |
$14.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.41
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.41
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$23.63
|
| Rate for Payer: Heritage Provider Network Transplant |
$23.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$23.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.31
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.67
|
| Rate for Payer: United Healthcare All Other HMO |
$11.67
|
| Rate for Payer: United Healthcare HMO Rider |
$11.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.41
|
|
|
HC TRACH CHANGE
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$317.28 |
| Max. Negotiated Rate |
$1,123.70 |
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.80
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
|
|
HC TRACH CHANGE
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
900801125
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$195.17 |
| Max. Negotiated Rate |
$1,123.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$867.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$787.65
|
| Rate for Payer: Blue Distinction Transplant |
$793.20
|
| Rate for Payer: Blue Shield of California Commercial |
$781.30
|
| Rate for Payer: Blue Shield of California EPN |
$620.02
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna of CA HMO |
$846.08
|
| Rate for Payer: Cigna of CA PPO |
$978.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$991.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$793.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$793.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC TRACHEOBRONCH VIA TRACHESOTOMY
|
Facility
|
IP
|
$3,313.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
900501297
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$795.12 |
| Max. Negotiated Rate |
$2,816.05 |
| Rate for Payer: Cash Price |
$1,490.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,325.20
|
| Rate for Payer: Galaxy Health WC |
$2,816.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,987.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,209.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,262.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$795.12
|
| Rate for Payer: Multiplan Commercial |
$2,650.40
|
| Rate for Payer: Networks By Design Commercial |
$2,153.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,816.05
|
|
