|
HC ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$2,089.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$728.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,464.48
|
| Rate for Payer: BCBS Transplant Transplant |
$1,474.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,452.68
|
| Rate for Payer: Blue Shield of California EPN |
$1,152.80
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cash Price |
$1,106.10
|
| Rate for Payer: Cigna of CA HMO |
$1,573.12
|
| Rate for Payer: Cigna of CA PPO |
$1,818.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,843.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,966.40
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,474.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
IP
|
$1,437.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$344.88 |
| Max. Negotiated Rate |
$1,221.45 |
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$574.80
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$547.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.88
|
| Rate for Payer: Multiplan Commercial |
$1,149.60
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
OP
|
$1,437.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$1,221.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$395.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$856.16
|
| Rate for Payer: BCBS Transplant Transplant |
$862.20
|
| Rate for Payer: Blue Shield of California Commercial |
$849.27
|
| Rate for Payer: Blue Shield of California EPN |
$673.95
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Cash Price |
$646.65
|
| Rate for Payer: Cigna of CA HMO |
$919.68
|
| Rate for Payer: Cigna of CA PPO |
$1,063.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,221.45
|
| Rate for Payer: Global Benefits Group Commercial |
$862.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,077.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$225.27
|
| Rate for Payer: Heritage Provider Network Transplant |
$225.27
|
| Rate for Payer: IEHP Medi-Cal |
$222.52
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$222.52
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$958.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,149.60
|
| Rate for Payer: Networks By Design Commercial |
$934.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,221.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$862.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$862.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$862.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
IP
|
$284.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$241.40 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
OP
|
$284.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$361.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$156.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$156.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$170.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna of CA PPO |
$210.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.40
|
| Rate for Payer: Dignity Health Media |
$241.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$213.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.16
|
| Rate for Payer: Multiplan Commercial |
$227.20
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC UNLISTED INVASIVE FETAL PROC
|
Facility
OP
|
$583.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.35
|
| Rate for Payer: BCBS Transplant Transplant |
$349.80
|
| Rate for Payer: Blue Shield of California Commercial |
$429.67
|
| Rate for Payer: Blue Shield of California EPN |
$340.47
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA HMO |
$373.12
|
| Rate for Payer: Cigna of CA PPO |
$431.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$437.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$408.31
|
| Rate for Payer: IEHP Medi-Cal |
$403.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$403.33
|
| Rate for Payer: IEHP Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.50
|
| Rate for Payer: United Healthcare All Other HMO |
$291.50
|
| Rate for Payer: United Healthcare HMO Rider |
$291.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC UNLISTED INVASIVE FETAL PROC
|
Facility
IP
|
$583.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC UNLISTED INVASIVE FETAL PROC ADD FETUS
|
Facility
OP
|
$583.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.35
|
| Rate for Payer: BCBS Transplant Transplant |
$349.80
|
| Rate for Payer: Blue Shield of California Commercial |
$429.67
|
| Rate for Payer: Blue Shield of California EPN |
$340.47
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: Cigna of CA HMO |
$373.12
|
| Rate for Payer: Cigna of CA PPO |
$431.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$373.46
|
| Rate for Payer: Dignity Health Media |
$248.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$273.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$248.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.97
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$437.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$408.31
|
| Rate for Payer: Heritage Provider Network Transplant |
$408.31
|
| Rate for Payer: IEHP Medi-Cal |
$403.33
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$403.33
|
| Rate for Payer: IEHP Medicare Advantage |
$248.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$313.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.62
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$349.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$349.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.50
|
| Rate for Payer: United Healthcare All Other HMO |
$291.50
|
| Rate for Payer: United Healthcare HMO Rider |
$291.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$373.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$273.87
|
| Rate for Payer: Vantage Medical Group Senior |
$248.97
|
|
|
HC UNLISTED INVASIVE FETAL PROC ADD FETUS
|
Facility
IP
|
$583.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.92 |
| Max. Negotiated Rate |
$495.55 |
| Rate for Payer: Cash Price |
$262.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$233.20
|
| Rate for Payer: Galaxy Health WC |
$495.55
|
| Rate for Payer: Global Benefits Group Commercial |
$349.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$388.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$222.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.92
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: Networks By Design Commercial |
$378.95
|
| Rate for Payer: Prime Health Services Commercial |
$495.55
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
OP
|
$4,897.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$363.98 |
| Max. Negotiated Rate |
$4,162.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,938.20
|
| Rate for Payer: Cash Price |
$2,203.65
|
| Rate for Payer: Cash Price |
$2,203.65
|
| Rate for Payer: Cash Price |
$2,203.65
|
| Rate for Payer: Cigna of CA PPO |
$3,623.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$4,162.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,938.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,672.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$596.93
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,266.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$3,917.60
|
| Rate for Payer: Networks By Design Commercial |
$3,183.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,162.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,938.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,938.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,448.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,448.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,448.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,448.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
IP
|
$4,897.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,175.28 |
| Max. Negotiated Rate |
$4,162.45 |
| Rate for Payer: Cash Price |
$2,203.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,958.80
|
| Rate for Payer: Galaxy Health WC |
$4,162.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,938.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,266.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,865.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.28
|
| Rate for Payer: Multiplan Commercial |
$3,917.60
|
| Rate for Payer: Networks By Design Commercial |
$3,183.05
|
| Rate for Payer: Prime Health Services Commercial |
$4,162.45
|
|
|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
IP
|
$4,137.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$992.88 |
| Max. Negotiated Rate |
$3,516.45 |
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,654.80
|
| Rate for Payer: Galaxy Health WC |
$3,516.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,482.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,759.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,576.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.88
|
| Rate for Payer: Multiplan Commercial |
$3,309.60
|
| Rate for Payer: Networks By Design Commercial |
$2,689.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,516.45
|
|
|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
OP
|
$4,137.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$305.19 |
| Max. Negotiated Rate |
$3,516.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,482.20
|
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: Cash Price |
$1,861.65
|
| Rate for Payer: Cigna of CA PPO |
$3,061.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$3,516.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,482.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,102.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,759.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$992.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$3,309.60
|
| Rate for Payer: Networks By Design Commercial |
$2,689.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,516.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,482.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,482.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,068.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,068.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,068.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC UNLISTED TX PROC 15MIN MCAL
|
Facility
OP
|
$204.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900400056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.54 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$133.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$112.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$122.40
|
| Rate for Payer: Blue Shield of California Commercial |
$407.00
|
| Rate for Payer: Blue Shield of California EPN |
$293.00
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna of CA HMO |
$130.56
|
| Rate for Payer: Cigna of CA PPO |
$150.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.40
|
| Rate for Payer: Dignity Health Media |
$173.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$153.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.96
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.40
|
| Rate for Payer: Vantage Medical Group Senior |
$173.40
|
|
|
HC UNLISTED TX PROC 15MIN MCAL
|
Facility
IP
|
$204.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900400056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$173.40 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.96
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.92 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$889.80
|
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: Cigna of CA PPO |
$1,097.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$1,260.55
|
| Rate for Payer: Global Benefits Group Commercial |
$889.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,112.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$596.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$596.93
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$363.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$989.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$458.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$1,186.40
|
| Rate for Payer: Networks By Design Commercial |
$963.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,260.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$889.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$889.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$741.50
|
| Rate for Payer: United Healthcare All Other HMO |
$741.50
|
| Rate for Payer: United Healthcare HMO Rider |
$741.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$741.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$355.92 |
| Max. Negotiated Rate |
$1,260.55 |
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.20
|
| Rate for Payer: Galaxy Health WC |
$1,260.55
|
| Rate for Payer: Global Benefits Group Commercial |
$889.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$989.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$565.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.92
|
| Rate for Payer: Multiplan Commercial |
$1,186.40
|
| Rate for Payer: Networks By Design Commercial |
$963.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,260.55
|
|
|
HC UNLIST PROC, FOOT OR TOES
|
Facility
IP
|
$923.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
900501584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.52 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC UNLIST PROC, FOOT OR TOES
|
Facility
OP
|
$923.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
900501584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.52 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$553.80
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$692.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$553.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$461.50
|
| Rate for Payer: United Healthcare All Other HMO |
$461.50
|
| Rate for Payer: United Healthcare HMO Rider |
$461.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$461.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC UNLIST PROC, HANDS OR FINGERS
|
Facility
IP
|
$704.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
900501535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.96 |
| Max. Negotiated Rate |
$598.40 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.60
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.96
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
|
|
HC UNLIST PROC, HANDS OR FINGERS
|
Facility
OP
|
$704.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
900501535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.96 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$422.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna of CA PPO |
$520.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$528.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$422.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.00
|
| Rate for Payer: United Healthcare All Other HMO |
$352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$352.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC UNLIST PROC, PELVIS OR HIP JNT
|
Facility
IP
|
$923.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
900501429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.52 |
| Max. Negotiated Rate |
$784.55 |
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.20
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$351.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
|
|
HC UNLIST PROC, PELVIS OR HIP JNT
|
Facility
OP
|
$923.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
900501429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.52 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$553.80
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cash Price |
$415.35
|
| Rate for Payer: Cigna of CA PPO |
$683.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$784.55
|
| Rate for Payer: Global Benefits Group Commercial |
$553.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$692.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$615.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: Networks By Design Commercial |
$599.95
|
| Rate for Payer: Prime Health Services Commercial |
$784.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$553.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$553.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$461.50
|
| Rate for Payer: United Healthcare All Other HMO |
$461.50
|
| Rate for Payer: United Healthcare HMO Rider |
$461.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$461.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC UNLIST PROC, SHOULDER
|
Facility
OP
|
$704.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
900501430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.96 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$294.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: BCBS Transplant Transplant |
$422.40
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna of CA PPO |
$520.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$441.96
|
| Rate for Payer: Dignity Health Media |
$294.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$294.64
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.64
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$528.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$483.21
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$294.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.82
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$422.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.00
|
| Rate for Payer: United Healthcare All Other HMO |
$352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$352.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$441.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.10
|
| Rate for Payer: Vantage Medical Group Senior |
$294.64
|
|
|
HC UNLIST PROC, SHOULDER
|
Facility
IP
|
$704.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
900501430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.96 |
| Max. Negotiated Rate |
$598.40 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.60
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.96
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
|
