|
HC VEP, CHECKERBOARD/FLASH
|
Facility
|
IP
|
$1,781.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$427.44 |
| Max. Negotiated Rate |
$1,513.85 |
| Rate for Payer: Cash Price |
$801.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$712.40
|
| Rate for Payer: Galaxy Health WC |
$1,513.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,068.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,187.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$678.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$427.44
|
| Rate for Payer: Multiplan Commercial |
$1,424.80
|
| Rate for Payer: Networks By Design Commercial |
$1,157.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,513.85
|
|
|
HC VERTEBRAL UNI
|
Facility
|
IP
|
$17,995.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,318.80 |
| Max. Negotiated Rate |
$15,295.75 |
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,198.00
|
| Rate for Payer: Galaxy Health WC |
$15,295.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,797.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,002.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,856.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,318.80
|
| Rate for Payer: Multiplan Commercial |
$14,396.00
|
| Rate for Payer: Networks By Design Commercial |
$11,696.75
|
| Rate for Payer: Prime Health Services Commercial |
$15,295.75
|
|
|
HC VERTEBRAL UNI
|
Facility
|
OP
|
$17,995.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$534.77 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,866.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,797.00
|
| 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 |
$8,097.75
|
| Rate for Payer: Cash Price |
$8,097.75
|
| Rate for Payer: Cigna of CA PPO |
$13,316.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Dignity Health Media |
$6,866.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,552.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,269.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6,866.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6,866.07
|
| Rate for Payer: Galaxy Health WC |
$15,295.75
|
| Rate for Payer: Global Benefits Group Commercial |
$10,797.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13,496.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,260.35
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,260.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,123.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,866.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,002.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,866.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,318.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,651.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,200.53
|
| Rate for Payer: Multiplan Commercial |
$14,396.00
|
| Rate for Payer: Networks By Design Commercial |
$11,696.75
|
| Rate for Payer: Prime Health Services Commercial |
$15,295.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,797.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,299.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,552.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6,866.07
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
IP
|
$1,324.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$317.76 |
| Max. Negotiated Rate |
$1,125.40 |
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.60
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$504.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
OP
|
$1,324.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.83 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$794.40
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna of CA PPO |
$979.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$1,125.40
|
| Rate for Payer: Global Benefits Group Commercial |
$794.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$993.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$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 |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$883.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$1,059.20
|
| Rate for Payer: Networks By Design Commercial |
$860.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,125.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$794.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$662.00
|
| Rate for Payer: United Healthcare All Other HMO |
$662.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$662.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
|
IP
|
$562.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$134.88 |
| Max. Negotiated Rate |
$477.70 |
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.80
|
| Rate for Payer: Galaxy Health WC |
$477.70
|
| Rate for Payer: Global Benefits Group Commercial |
$337.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.88
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: Networks By Design Commercial |
$365.30
|
| Rate for Payer: Prime Health Services Commercial |
$477.70
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
|
OP
|
$562.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$139.39
|
| 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 |
$334.84
|
| Rate for Payer: Blue Distinction Transplant |
$337.20
|
| Rate for Payer: Blue Shield of California Commercial |
$332.14
|
| Rate for Payer: Blue Shield of California EPN |
$263.58
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cash Price |
$252.90
|
| Rate for Payer: Cigna of CA HMO |
$359.68
|
| Rate for Payer: Cigna of CA PPO |
$415.88
|
| 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 |
$477.70
|
| Rate for Payer: Global Benefits Group Commercial |
$337.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$421.50
|
| 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 |
$374.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.88
|
| 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 |
$449.60
|
| Rate for Payer: Networks By Design Commercial |
$365.30
|
| Rate for Payer: Prime Health Services Commercial |
$477.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.20
|
| 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 VITAMIN B12
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900910830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$137.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$125.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.53
|
| Rate for Payer: Blue Distinction Transplant |
$18.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19.38
|
| Rate for Payer: Blue Shield of California EPN |
$15.36
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Media |
$15.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$24.73
|
| Rate for Payer: Heritage Provider Network Transplant |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$24.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC VITAMIN D TOTAL
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.80 |
| Max. Negotiated Rate |
$270.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$246.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.08
|
| Rate for Payer: Blue Distinction Transplant |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$29.07
|
| Rate for Payer: Blue Shield of California EPN |
$23.04
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cash Price |
$20.25
|
| Rate for Payer: Cigna of CA HMO |
$28.80
|
| Rate for Payer: Cigna of CA PPO |
$33.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Media |
$29.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$29.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$38.25
|
| Rate for Payer: Global Benefits Group Commercial |
$27.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$48.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$48.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$47.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Networks By Design Commercial |
$29.25
|
| Rate for Payer: Prime Health Services Commercial |
$38.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC VOIDING CYSTOGRAM
|
Facility
|
IP
|
$2,104.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
909301428
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$504.96 |
| Max. Negotiated Rate |
$1,788.40 |
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$841.60
|
| Rate for Payer: Galaxy Health WC |
$1,788.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,262.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.96
|
| Rate for Payer: Multiplan Commercial |
$1,683.20
|
| Rate for Payer: Networks By Design Commercial |
$1,367.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,788.40
|
|
|
HC VOIDING CYSTOGRAM
|
Facility
|
OP
|
$2,104.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
909301428
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$128.25 |
| Max. Negotiated Rate |
$1,788.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,224.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,253.56
|
| Rate for Payer: Blue Distinction Transplant |
$1,262.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,243.46
|
| Rate for Payer: Blue Shield of California EPN |
$986.78
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cigna of CA HMO |
$1,346.56
|
| Rate for Payer: Cigna of CA PPO |
$1,556.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,788.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,262.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,578.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,683.20
|
| Rate for Payer: Networks By Design Commercial |
$1,367.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,788.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,262.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,262.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC VOIDING CYSTO URETHROGRAM
|
Facility
|
OP
|
$1,354.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
909001902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$1,150.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$468.58
|
| 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 |
$411.91
|
| Rate for Payer: Blue Distinction Transplant |
$812.40
|
| Rate for Payer: Blue Shield of California Commercial |
$800.21
|
| Rate for Payer: Blue Shield of California EPN |
$635.03
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna of CA HMO |
$866.56
|
| Rate for Payer: Cigna of CA PPO |
$1,001.96
|
| 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 |
$1,150.90
|
| Rate for Payer: Global Benefits Group Commercial |
$812.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,015.50
|
| 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 |
$903.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.96
|
| 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 |
$1,083.20
|
| Rate for Payer: Networks By Design Commercial |
$880.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$812.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$812.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| 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 VOIDING CYSTO URETHROGRAM
|
Facility
|
IP
|
$1,354.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
909001902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$324.96 |
| Max. Negotiated Rate |
$1,150.90 |
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.60
|
| Rate for Payer: Galaxy Health WC |
$1,150.90
|
| Rate for Payer: Global Benefits Group Commercial |
$812.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$903.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.96
|
| Rate for Payer: Multiplan Commercial |
$1,083.20
|
| Rate for Payer: Networks By Design Commercial |
$880.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.90
|
|
|
HC VZV AB
|
Facility
|
OP
|
$27.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913532
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.57
|
| Rate for Payer: Blue Distinction Transplant |
$16.20
|
| Rate for Payer: Blue Shield of California Commercial |
$17.44
|
| Rate for Payer: Blue Shield of California EPN |
$13.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Media |
$12.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$20.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC WADA MONITORING
|
Facility
|
IP
|
$5,350.00
|
|
|
Service Code
|
CPT 95958
|
| Hospital Charge Code |
900600700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,284.00 |
| Max. Negotiated Rate |
$4,547.50 |
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,140.00
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.00
|
| Rate for Payer: Multiplan Commercial |
$4,280.00
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
|
|
HC WADA MONITORING
|
Facility
|
OP
|
$5,350.00
|
|
|
Service Code
|
CPT 95958
|
| Hospital Charge Code |
900600700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$469.79 |
| Max. Negotiated Rate |
$4,547.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,646.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,306.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,187.53
|
| Rate for Payer: Blue Distinction Transplant |
$3,210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,161.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,509.15
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cigna of CA HMO |
$3,424.00
|
| Rate for Payer: Cigna of CA PPO |
$3,959.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Dignity Health Media |
$1,306.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,763.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,306.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,306.33
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,012.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,142.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,142.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,116.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$2,116.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,306.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,306.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,645.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.48
|
| Rate for Payer: Multiplan Commercial |
$4,280.00
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1,306.33
|
|
|
HC WART DESTRUCTION SINGLE
|
Facility
|
IP
|
$7,602.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,824.48 |
| Max. Negotiated Rate |
$6,461.70 |
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,040.80
|
| Rate for Payer: Galaxy Health WC |
$6,461.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,561.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,070.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,896.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,824.48
|
| Rate for Payer: Multiplan Commercial |
$6,081.60
|
| Rate for Payer: Networks By Design Commercial |
$4,941.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,461.70
|
|
|
HC WART DESTRUCTION SINGLE
|
Facility
|
OP
|
$7,602.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$342.80 |
| Max. Negotiated Rate |
$6,461.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,561.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,602.67
|
| Rate for Payer: Blue Shield of California EPN |
$4,439.57
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cigna of CA HMO |
$4,865.28
|
| Rate for Payer: Cigna of CA PPO |
$5,625.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$6,461.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,561.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,701.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,691.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,691.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,070.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,824.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$6,081.60
|
| Rate for Payer: Networks By Design Commercial |
$4,941.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,461.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,561.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,561.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,801.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,801.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,801.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,801.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$562.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.21
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$145.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.20
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Media |
$62.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$100.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$278.40 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.00
|
| Rate for Payer: Galaxy Health WC |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$773.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.40
|
| Rate for Payer: Multiplan Commercial |
$928.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.45 |
| 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 |
$696.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna of CA PPO |
$858.40
|
| 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 |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$870.00
|
| 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 |
$773.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.40
|
| 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 |
$928.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$580.00
|
| Rate for Payer: United Healthcare All Other HMO |
$580.00
|
| Rate for Payer: United Healthcare HMO Rider |
$580.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$580.00
|
| 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 WEDGING OF CLUBFOOT CAST
|
Facility
|
OP
|
$995.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| 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 |
$503.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$597.00
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| 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 |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.50
|
| Rate for Payer: United Healthcare All Other HMO |
$497.50
|
| Rate for Payer: United Healthcare HMO Rider |
$497.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
|
IP
|
$995.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC WEEKLY PHYSICS
|
Facility
|
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$380.64 |
| Max. Negotiated Rate |
$1,348.10 |
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$634.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$634.40
|
| Rate for Payer: Galaxy Health WC |
$1,348.10
|
| Rate for Payer: Global Benefits Group Commercial |
$951.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$604.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.64
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Networks By Design Commercial |
$1,030.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.10
|
|
|
HC WEEKLY PHYSICS
|
Facility
|
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$332.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$686.29
|
| Rate for Payer: Blue Distinction Transplant |
$951.60
|
| Rate for Payer: Blue Shield of California Commercial |
$937.33
|
| Rate for Payer: Blue Shield of California EPN |
$743.83
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cigna of CA HMO |
$1,015.04
|
| Rate for Payer: Cigna of CA PPO |
$1,173.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,348.10
|
| Rate for Payer: Global Benefits Group Commercial |
$951.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,189.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$278.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$274.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Networks By Design Commercial |
$1,030.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$951.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
