|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
IP
|
$9,424.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,261.76 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Cash Price |
$4,240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,769.60
|
| Rate for Payer: Galaxy Health WC |
$8,010.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,654.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,285.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,590.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,261.76
|
| Rate for Payer: Multiplan Commercial |
$7,539.20
|
| Rate for Payer: Networks By Design Commercial |
$6,125.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,010.40
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
OP
|
$9,424.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$320.44 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,654.40
|
| Rate for Payer: Cash Price |
$4,240.80
|
| Rate for Payer: Cash Price |
$4,240.80
|
| Rate for Payer: Cash Price |
$4,240.80
|
| Rate for Payer: Cigna of CA PPO |
$6,973.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$8,010.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,654.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,068.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| 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 |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,285.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,261.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$7,539.20
|
| Rate for Payer: Networks By Design Commercial |
$6,125.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,010.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,654.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,712.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,712.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,712.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC TREAT INCOMPLETE ABORTION SURG
|
Facility
|
IP
|
$9,424.00
|
|
|
Service Code
|
CPT 59812
|
| Hospital Charge Code |
900501515
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,261.76 |
| Max. Negotiated Rate |
$8,010.40 |
| Rate for Payer: Cash Price |
$4,240.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,769.60
|
| Rate for Payer: Galaxy Health WC |
$8,010.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,654.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,285.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,590.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,261.76
|
| Rate for Payer: Multiplan Commercial |
$7,539.20
|
| Rate for Payer: Networks By Design Commercial |
$6,125.60
|
| Rate for Payer: Prime Health Services Commercial |
$8,010.40
|
|
|
HC TREATMENT ROOM
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.32 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC TREATMENT ROOM
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600101
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$442.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.10
|
| Rate for Payer: Blue Distinction Transplant |
$385.80
|
| Rate for Payer: Blue Shield of California Commercial |
$473.89
|
| Rate for Payer: Blue Shield of California EPN |
$375.51
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.55
|
| Rate for Payer: Dignity Health Media |
$546.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$482.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.55
|
| Rate for Payer: Vantage Medical Group Senior |
$546.55
|
|
|
HC TREATMENT ROOM
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.32 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC TREATMENT ROOM
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$154.32 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC TREATMENT ROOM
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$442.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.10
|
| Rate for Payer: Blue Distinction Transplant |
$385.80
|
| Rate for Payer: Blue Shield of California Commercial |
$473.89
|
| Rate for Payer: Blue Shield of California EPN |
$375.51
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.55
|
| Rate for Payer: Dignity Health Media |
$546.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$482.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.55
|
| Rate for Payer: Vantage Medical Group Senior |
$546.55
|
|
|
HC TREATMENT ROOM
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
912900120
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$442.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$383.10
|
| Rate for Payer: Blue Distinction Transplant |
$385.80
|
| Rate for Payer: Blue Shield of California Commercial |
$473.89
|
| Rate for Payer: Blue Shield of California EPN |
$375.51
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cash Price |
$289.35
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$546.55
|
| Rate for Payer: Dignity Health Media |
$546.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$546.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$482.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$546.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$546.55
|
| Rate for Payer: Vantage Medical Group Senior |
$546.55
|
|
|
HC TREAT PELVIC RING FX
|
Facility
|
IP
|
$726.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.24 |
| Max. Negotiated Rate |
$617.10 |
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.40
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.24
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
|
|
HC TREAT PELVIC RING FX
|
Facility
|
OP
|
$726.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
900501652
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$174.24 |
| 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 |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$435.60
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cash Price |
$326.70
|
| Rate for Payer: Cigna of CA PPO |
$537.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$617.10
|
| Rate for Payer: Global Benefits Group Commercial |
$435.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$544.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$484.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$174.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$580.80
|
| Rate for Payer: Networks By Design Commercial |
$471.90
|
| Rate for Payer: Prime Health Services Commercial |
$617.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$363.00
|
| Rate for Payer: United Healthcare All Other HMO |
$363.00
|
| Rate for Payer: United Healthcare HMO Rider |
$363.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$363.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
IP
|
$2,069.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$496.56 |
| Max. Negotiated Rate |
$1,758.65 |
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$827.60
|
| Rate for Payer: Galaxy Health WC |
$1,758.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,241.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.56
|
| Rate for Payer: Multiplan Commercial |
$1,655.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,758.65
|
|
|
HC TREAT SPLIT WOUND CLOS, SIMP
|
Facility
|
OP
|
$2,069.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
900501539
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$496.56 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,241.40
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Cash Price |
$931.05
|
| Rate for Payer: Cigna of CA PPO |
$1,531.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,758.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,241.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,551.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,286.92
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,286.92
|
| 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 |
$784.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$988.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,655.20
|
| Rate for Payer: Networks By Design Commercial |
$1,344.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,758.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,241.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,034.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,034.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,034.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,034.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$239.10 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$732.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna of CA PPO |
$902.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$915.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| 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 |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$976.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$610.00
|
| Rate for Payer: United Healthcare All Other HMO |
$610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$610.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$610.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.80 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.00
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.80
|
| Rate for Payer: Multiplan Commercial |
$976.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$239.10 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$732.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna of CA PPO |
$902.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$915.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$976.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$292.80 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.00
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.80
|
| Rate for Payer: Multiplan Commercial |
$976.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
IP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.80 |
| Max. Negotiated Rate |
$1,037.00 |
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$488.00
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$464.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.80
|
| Rate for Payer: Multiplan Commercial |
$976.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
|
|
HC TREAT SPLIT WOUND CLOS, W/PACK
|
Facility
|
OP
|
$1,220.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
900501577
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$239.10 |
| 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 |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$732.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.14
|
| Rate for Payer: Blue Shield of California EPN |
$712.48
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cash Price |
$549.00
|
| Rate for Payer: Cigna of CA HMO |
$780.80
|
| Rate for Payer: Cigna of CA PPO |
$902.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,037.00
|
| Rate for Payer: Global Benefits Group Commercial |
$732.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$915.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$807.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$239.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$976.00
|
| Rate for Payer: Networks By Design Commercial |
$793.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,037.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$732.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$732.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.92 |
| Max. Negotiated Rate |
$1,366.80 |
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$643.20
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
|
|
HC TREAT TARSAL BONE FX, W/O MANI
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
CPT 28450
|
| Hospital Charge Code |
900501478
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$274.40 |
| 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 |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$964.80
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna of CA PPO |
$1,189.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$1,366.80
|
| Rate for Payer: Global Benefits Group Commercial |
$964.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,206.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,072.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: Networks By Design Commercial |
$1,045.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,366.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$964.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$804.00
|
| Rate for Payer: United Healthcare All Other HMO |
$804.00
|
| Rate for Payer: United Healthcare HMO Rider |
$804.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$804.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TREAT WRIST BONE FX, W/O MANIP
|
Facility
|
IP
|
$2,446.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
900501374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$587.04 |
| Max. Negotiated Rate |
$2,079.10 |
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.40
|
| Rate for Payer: Galaxy Health WC |
$2,079.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,631.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.04
|
| Rate for Payer: Multiplan Commercial |
$1,956.80
|
| Rate for Payer: Networks By Design Commercial |
$1,589.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,079.10
|
|
|
HC TREAT WRIST BONE FX, W/O MANIP
|
Facility
|
OP
|
$2,446.00
|
|
|
Service Code
|
CPT 25622
|
| Hospital Charge Code |
900501374
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$294.64 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,467.60
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cigna of CA PPO |
$1,810.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$2,079.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,834.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,631.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$1,956.80
|
| Rate for Payer: Networks By Design Commercial |
$1,589.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,079.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,223.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,223.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,223.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,223.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC TRICHROME TEST
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900911728
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$420.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$420.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.54
|
| Rate for Payer: Blue Distinction Transplant |
$50.40
|
| Rate for Payer: Blue Shield of California Commercial |
$54.26
|
| Rate for Payer: Blue Shield of California EPN |
$43.01
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.63
|
| Rate for Payer: Dignity Health Media |
$76.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.17
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$76.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.42
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$125.33
|
| Rate for Payer: Heritage Provider Network Transplant |
$125.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$123.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$76.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$102.40
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.06
|
| Rate for Payer: Vantage Medical Group Senior |
$76.42
|
|
|
HC TRIGLYCERIDES
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
900910234
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$52.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.21
|
| Rate for Payer: Blue Distinction Transplant |
$11.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12.27
|
| Rate for Payer: Blue Shield of California EPN |
$9.73
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cash Price |
$8.55
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.61
|
| Rate for Payer: Dignity Health Media |
$5.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.75
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.41
|
| Rate for Payer: Heritage Provider Network Transplant |
$9.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$9.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.65
|
| Rate for Payer: United Healthcare All Other HMO |
$4.65
|
| Rate for Payer: United Healthcare HMO Rider |
$4.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.31
|
| Rate for Payer: Vantage Medical Group Senior |
$5.74
|
|
