|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
IP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
905355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$772.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$772.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,471.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,391.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$927.12
|
| Rate for Payer: Multiplan Commercial |
$3,090.40
|
| Rate for Payer: Networks By Design Commercial |
$1,931.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
|
|
HC HYDRAULIC SWING MINI HI ACTVTY
|
Facility
|
OP
|
$3,863.00
|
|
|
Service Code
|
CPT L5826
|
| Hospital Charge Code |
915355826
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$927.12 |
| Max. Negotiated Rate |
$3,283.55 |
| Rate for Payer: Adventist Health Commercial |
$1,583.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,124.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,237.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2,850.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,877.42
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cash Price |
$1,738.35
|
| Rate for Payer: Cigna of CA HMO |
$2,704.10
|
| Rate for Payer: Cigna of CA PPO |
$2,704.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,283.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,283.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,545.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,545.20
|
| Rate for Payer: Galaxy Health WC |
$3,283.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,317.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,350.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,576.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,658.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,391.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$927.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,704.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,704.10
|
| Rate for Payer: Multiplan Commercial |
$3,090.40
|
| Rate for Payer: Networks By Design Commercial |
$1,931.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,283.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,317.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,317.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,449.78
|
| Rate for Payer: United Healthcare All Other HMO |
$1,411.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,380.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,265.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,283.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,283.55
|
|
|
HC HYDROCOIL
|
Facility
|
OP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$3,182.40 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,059.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,808.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,168.52
|
| Rate for Payer: Blue Shield of California Commercial |
$2,763.07
|
| Rate for Payer: Blue Shield of California EPN |
$1,819.58
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cigna of CA HMO |
$2,620.80
|
| Rate for Payer: Cigna of CA PPO |
$2,620.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,182.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,182.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,317.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$898.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,620.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,620.80
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Networks By Design Commercial |
$1,872.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,246.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,246.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,405.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,338.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,226.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,182.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,182.40
|
|
|
HC HYDROCOIL
|
Facility
|
IP
|
$3,744.00
|
|
| Hospital Charge Code |
909020028
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$748.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$748.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cash Price |
$1,684.80
|
| Rate for Payer: Cigna of CA HMO |
$2,620.80
|
| Rate for Payer: Cigna of CA PPO |
$2,620.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,497.60
|
| Rate for Payer: Galaxy Health WC |
$3,182.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,246.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,497.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,426.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,317.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$898.56
|
| Rate for Payer: Multiplan Commercial |
$2,995.20
|
| Rate for Payer: Networks By Design Commercial |
$1,872.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,182.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,405.12
|
| Rate for Payer: United Healthcare All Other HMO |
$1,367.68
|
| Rate for Payer: United Healthcare HMO Rider |
$1,338.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,226.16
|
|
|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
|
IP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$512.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.72
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC HYDROCOIL DETACHMENT CONTROLLE
|
Facility
|
OP
|
$828.00
|
|
| Hospital Charge Code |
909020029
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$165.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$543.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$621.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$508.47
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna of CA HMO |
$529.92
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$703.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Senior |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$512.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$579.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC HYDROGEL 4OZ WOUND DRESSING
|
Facility
|
IP
|
$46.17
|
|
|
Service Code
|
CPT A6248
|
| Hospital Charge Code |
901698768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$39.24 |
| Rate for Payer: Adventist Health Commercial |
$9.23
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Senior |
$18.47
|
| Rate for Payer: Galaxy Health WC |
$39.24
|
| Rate for Payer: Global Benefits Group Commercial |
$27.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.08
|
| Rate for Payer: Multiplan Commercial |
$36.94
|
| Rate for Payer: Networks By Design Commercial |
$30.01
|
| Rate for Payer: Prime Health Services Commercial |
$39.24
|
|
|
HC HYDROGEL 4OZ WOUND DRESSING
|
Facility
|
OP
|
$46.17
|
|
|
Service Code
|
CPT A6248
|
| Hospital Charge Code |
901698768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.23 |
| Max. Negotiated Rate |
$39.24 |
| Rate for Payer: Adventist Health Commercial |
$9.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.35
|
| Rate for Payer: Cash Price |
$20.78
|
| Rate for Payer: Cigna of CA HMO |
$29.55
|
| Rate for Payer: Cigna of CA PPO |
$34.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.47
|
| Rate for Payer: EPIC Health Plan Senior |
$18.47
|
| Rate for Payer: Galaxy Health WC |
$39.24
|
| Rate for Payer: Global Benefits Group Commercial |
$27.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.32
|
| Rate for Payer: Multiplan Commercial |
$36.94
|
| Rate for Payer: Networks By Design Commercial |
$30.01
|
| Rate for Payer: Prime Health Services Commercial |
$39.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.09
|
| Rate for Payer: United Healthcare All Other HMO |
$23.09
|
| Rate for Payer: United Healthcare HMO Rider |
$23.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.24
|
| Rate for Payer: Vantage Medical Group Senior |
$39.24
|
|
|
HC HYDROGEL WOUND GEL 4 OZ
|
Facility
|
OP
|
$50.35
|
|
| Hospital Charge Code |
901698843
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$42.80 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.92
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: Cigna of CA HMO |
$32.22
|
| Rate for Payer: Cigna of CA PPO |
$37.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.24
|
| Rate for Payer: Multiplan Commercial |
$40.28
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.18
|
| Rate for Payer: United Healthcare All Other HMO |
$25.18
|
| Rate for Payer: United Healthcare HMO Rider |
$25.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.80
|
| Rate for Payer: Vantage Medical Group Senior |
$42.80
|
|
|
HC HYDROGEL WOUND GEL 4 OZ
|
Facility
|
IP
|
$50.35
|
|
| Hospital Charge Code |
901698843
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$42.80 |
| Rate for Payer: Adventist Health Commercial |
$10.07
|
| Rate for Payer: Cash Price |
$22.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Senior |
$20.14
|
| Rate for Payer: Galaxy Health WC |
$42.80
|
| Rate for Payer: Global Benefits Group Commercial |
$30.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.08
|
| Rate for Payer: Multiplan Commercial |
$40.28
|
| Rate for Payer: Networks By Design Commercial |
$32.73
|
| Rate for Payer: Prime Health Services Commercial |
$42.80
|
|
|
HC HYMENOTOMY, SIMPLE INCISION
|
Facility
|
IP
|
$10,901.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
900506442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,180.20 |
| Max. Negotiated Rate |
$9,265.85 |
| Rate for Payer: Adventist Health Commercial |
$2,180.20
|
| Rate for Payer: Cash Price |
$4,905.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,360.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,360.40
|
| Rate for Payer: Galaxy Health WC |
$9,265.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,540.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,270.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,153.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,747.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,616.24
|
| Rate for Payer: Multiplan Commercial |
$8,720.80
|
| Rate for Payer: Networks By Design Commercial |
$7,085.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,265.85
|
|
|
HC HYMENOTOMY, SIMPLE INCISION
|
Facility
|
OP
|
$10,901.00
|
|
|
Service Code
|
CPT 56442
|
| Hospital Charge Code |
900506442
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.59 |
| Max. Negotiated Rate |
$9,265.85 |
| Rate for Payer: Adventist Health Commercial |
$2,180.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$4,905.45
|
| Rate for Payer: Cash Price |
$4,905.45
|
| Rate for Payer: Cash Price |
$4,905.45
|
| Rate for Payer: Cigna of CA HMO |
$6,976.64
|
| Rate for Payer: Cigna of CA PPO |
$8,066.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$9,265.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,540.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,270.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,616.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$8,720.80
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$7,085.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,265.85
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,540.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,450.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,450.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,450.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,450.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
|
|
HC HYSTEROSALPINGOGRAM
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
909000176
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$344.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$283.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$344.25
|
| Rate for Payer: Vantage Medical Group Senior |
$344.25
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.49 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$807.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.27
|
| Rate for Payer: Blue Shield of California Commercial |
$753.37
|
| Rate for Payer: Blue Shield of California EPN |
$497.32
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: Cigna of CA HMO |
$787.84
|
| Rate for Payer: Cigna of CA PPO |
$910.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$738.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$738.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC HYSTEROSALPINGOGRAM EXAM
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 74740
|
| Hospital Charge Code |
909001930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.20 |
| Max. Negotiated Rate |
$1,046.35 |
| Rate for Payer: Adventist Health Commercial |
$246.20
|
| Rate for Payer: Cash Price |
$553.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$492.40
|
| Rate for Payer: Galaxy Health WC |
$1,046.35
|
| Rate for Payer: Global Benefits Group Commercial |
$738.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$821.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$761.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.44
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Networks By Design Commercial |
$800.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,046.35
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$1,247.80 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,083.38
|
| Rate for Payer: Blue Shield of California EPN |
$713.45
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna of CA HMO |
$1,027.60
|
| Rate for Payer: Cigna of CA PPO |
$1,027.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$587.20
|
| Rate for Payer: EPIC Health Plan Senior |
$587.20
|
| Rate for Payer: Galaxy Health WC |
$1,247.80
|
| Rate for Payer: Global Benefits Group Commercial |
$880.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$559.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$908.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.32
|
| Rate for Payer: Multiplan Commercial |
$1,174.40
|
| Rate for Payer: Networks By Design Commercial |
$734.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$550.94
|
| Rate for Payer: United Healthcare All Other HMO |
$536.26
|
| Rate for Payer: United Healthcare HMO Rider |
$524.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.77
|
|
|
HC I-111 OXINE PER .5 MCI
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
CPT A9547
|
| Hospital Charge Code |
909301529
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$293.60 |
| Max. Negotiated Rate |
$1,267.13 |
| Rate for Payer: Adventist Health Commercial |
$293.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$965.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$849.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$849.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$901.50
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cash Price |
$660.60
|
| Rate for Payer: Cigna of CA HMO |
$1,027.60
|
| Rate for Payer: Cigna of CA PPO |
$1,027.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$965.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$849.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$849.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,043.06
|
| Rate for Payer: EPIC Health Plan Senior |
$772.64
|
| Rate for Payer: Galaxy Health WC |
$1,247.80
|
| Rate for Payer: Global Benefits Group Commercial |
$880.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,267.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$391.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$772.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$979.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$772.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$973.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,035.34
|
| Rate for Payer: Multiplan Commercial |
$1,174.40
|
| Rate for Payer: Networks By Design Commercial |
$734.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,247.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$880.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$880.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$550.94
|
| Rate for Payer: United Healthcare All Other HMO |
$536.26
|
| Rate for Payer: United Healthcare HMO Rider |
$524.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$480.77
|
| Rate for Payer: Upland Medical Group Pediatric |
$772.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$965.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$849.90
|
| Rate for Payer: Vantage Medical Group Senior |
$849.90
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$170.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$232.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$190.37
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$263.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$263.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$263.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$150.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$217.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$217.00
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.34
|
| Rate for Payer: United Healthcare All Other HMO |
$113.24
|
| Rate for Payer: United Healthcare HMO Rider |
$110.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$263.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$263.50
|
| Rate for Payer: Vantage Medical Group Senior |
$263.50
|
|
|
HC I-123 CAPSULES PER 100-999 UCI
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT A9516
|
| Hospital Charge Code |
909301511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$263.50 |
| Rate for Payer: Adventist Health Commercial |
$62.00
|
| Rate for Payer: Blue Shield of California Commercial |
$228.78
|
| Rate for Payer: Blue Shield of California EPN |
$150.66
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna of CA HMO |
$217.00
|
| Rate for Payer: Cigna of CA PPO |
$217.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$191.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Networks By Design Commercial |
$155.00
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.34
|
| Rate for Payer: United Healthcare All Other HMO |
$113.24
|
| Rate for Payer: United Healthcare HMO Rider |
$110.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$101.53
|
|
|
HC I-125 SEED
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$223.55 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.33
|
| Rate for Payer: Blue Shield of California Commercial |
$194.09
|
| Rate for Payer: Blue Shield of California EPN |
$127.82
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.10
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
|
HC I-125 SEED
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT A4648
|
| Hospital Charge Code |
909301514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.12
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Blue Shield of California Commercial |
$323.24
|
| Rate for Payer: Blue Shield of California EPN |
$212.87
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
|
|
HC I-125 SERUM ALBUMIN PER 5 UCI
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT A9532
|
| Hospital Charge Code |
909301517
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$372.30 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$240.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$268.98
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna of CA HMO |
$306.60
|
| Rate for Payer: Cigna of CA PPO |
$306.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$372.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$372.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$372.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$306.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$306.60
|
| Rate for Payer: Multiplan Commercial |
$350.40
|
| Rate for Payer: Networks By Design Commercial |
$219.00
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.38
|
| Rate for Payer: United Healthcare All Other HMO |
$160.00
|
| Rate for Payer: United Healthcare HMO Rider |
$156.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$372.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$372.30
|
| Rate for Payer: Vantage Medical Group Senior |
$372.30
|
|
|
HC I-131 IOBENGUANE/MIBG PER.5MCI
|
Facility
|
OP
|
$5,753.00
|
|
|
Service Code
|
CPT A9508
|
| Hospital Charge Code |
909301519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$774.41 |
| Max. Negotiated Rate |
$4,890.05 |
| Rate for Payer: Adventist Health Commercial |
$1,150.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,890.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,164.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,314.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,532.92
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cash Price |
$2,588.85
|
| Rate for Payer: Cigna of CA HMO |
$4,027.10
|
| Rate for Payer: Cigna of CA PPO |
$4,027.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,890.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,890.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,890.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,301.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,301.20
|
| Rate for Payer: Galaxy Health WC |
$4,890.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,451.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$774.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,837.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$875.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,561.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,380.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,027.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,027.10
|
| Rate for Payer: Multiplan Commercial |
$4,602.40
|
| Rate for Payer: Networks By Design Commercial |
$2,876.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,890.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,451.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,451.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,159.10
|
| Rate for Payer: United Healthcare All Other HMO |
$2,101.57
|
| Rate for Payer: United Healthcare HMO Rider |
$2,056.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,884.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,890.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,890.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,890.05
|
|
