|
HC VOIDING CYSTOGRAM
|
Facility
OP
|
$2,104.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
909301428
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$128.25 |
| Max. Negotiated Rate |
$1,788.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,224.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,253.56
|
| Rate for Payer: BCBS Transplant Transplant |
$1,262.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,243.46
|
| Rate for Payer: Blue Shield of California EPN |
$986.78
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: Cigna of CA HMO |
$1,346.56
|
| Rate for Payer: Cigna of CA PPO |
$1,556.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,788.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,262.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,578.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: IEHP Medi-Cal |
$834.82
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$834.82
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,683.20
|
| Rate for Payer: Networks By Design Commercial |
$1,367.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,788.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,262.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,262.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,262.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC VOIDING CYSTOGRAM
|
Facility
IP
|
$2,104.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
909301428
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$504.96 |
| Max. Negotiated Rate |
$1,788.40 |
| Rate for Payer: Cash Price |
$946.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$841.60
|
| Rate for Payer: Galaxy Health WC |
$1,788.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,262.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,403.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$504.96
|
| Rate for Payer: Multiplan Commercial |
$1,683.20
|
| Rate for Payer: Networks By Design Commercial |
$1,367.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,788.40
|
|
|
HC VOIDING CYSTO URETHROGRAM
|
Facility
IP
|
$1,354.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
909001902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$324.96 |
| Max. Negotiated Rate |
$1,150.90 |
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.60
|
| Rate for Payer: Galaxy Health WC |
$1,150.90
|
| Rate for Payer: Global Benefits Group Commercial |
$812.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$903.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.96
|
| Rate for Payer: Multiplan Commercial |
$1,083.20
|
| Rate for Payer: Networks By Design Commercial |
$880.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.90
|
|
|
HC VOIDING CYSTO URETHROGRAM
|
Facility
OP
|
$1,354.00
|
|
|
Service Code
|
CPT 74455
|
| Hospital Charge Code |
909001902
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.12 |
| Max. Negotiated Rate |
$1,150.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$468.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$411.91
|
| Rate for Payer: BCBS Transplant Transplant |
$812.40
|
| Rate for Payer: Blue Shield of California Commercial |
$800.21
|
| Rate for Payer: Blue Shield of California EPN |
$635.03
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cash Price |
$609.30
|
| Rate for Payer: Cigna of CA HMO |
$866.56
|
| Rate for Payer: Cigna of CA PPO |
$1,001.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,150.90
|
| Rate for Payer: Global Benefits Group Commercial |
$812.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,015.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$502.10
|
| Rate for Payer: Heritage Provider Network Transplant |
$502.10
|
| Rate for Payer: IEHP Medi-Cal |
$495.98
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$495.98
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$903.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$115.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,083.20
|
| Rate for Payer: Networks By Design Commercial |
$880.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$812.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$812.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$812.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC VZV AB
|
Facility
OP
|
$27.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
900913532
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$117.57
|
| Rate for Payer: BCBS Transplant Transplant |
$16.20
|
| Rate for Payer: Blue Shield of California Commercial |
$17.44
|
| Rate for Payer: Blue Shield of California EPN |
$13.82
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cash Price |
$12.15
|
| Rate for Payer: Cigna of CA HMO |
$17.28
|
| Rate for Payer: Cigna of CA PPO |
$19.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Media |
$12.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.39
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.88
|
| Rate for Payer: Galaxy Health WC |
$22.95
|
| Rate for Payer: Global Benefits Group Commercial |
$16.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$20.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$21.12
|
| Rate for Payer: IEHP Medi-Cal |
$20.87
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$20.87
|
| Rate for Payer: IEHP Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: Networks By Design Commercial |
$17.55
|
| Rate for Payer: Prime Health Services Commercial |
$22.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
|
|
HC WADA MONITORING
|
Facility
IP
|
$5,350.00
|
|
|
Service Code
|
CPT 95958
|
| Hospital Charge Code |
900600700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,284.00 |
| Max. Negotiated Rate |
$4,547.50 |
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,140.00
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,038.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.00
|
| Rate for Payer: Multiplan Commercial |
$4,280.00
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
|
|
HC WADA MONITORING
|
Facility
OP
|
$5,350.00
|
|
|
Service Code
|
CPT 95958
|
| Hospital Charge Code |
900600700
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$469.79 |
| Max. Negotiated Rate |
$4,547.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,646.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,306.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,187.53
|
| Rate for Payer: BCBS Transplant Transplant |
$3,210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,161.85
|
| Rate for Payer: Blue Shield of California EPN |
$2,509.15
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cash Price |
$2,407.50
|
| Rate for Payer: Cigna of CA HMO |
$3,424.00
|
| Rate for Payer: Cigna of CA PPO |
$3,959.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Dignity Health Media |
$1,306.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,763.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,306.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,306.33
|
| Rate for Payer: Galaxy Health WC |
$4,547.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,210.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,012.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,142.38
|
| Rate for Payer: Heritage Provider Network Transplant |
$2,142.38
|
| Rate for Payer: IEHP Medi-Cal |
$2,116.25
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$2,116.25
|
| Rate for Payer: IEHP Medicare Advantage |
$1,306.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$469.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,306.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,284.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,645.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,750.48
|
| Rate for Payer: Multiplan Commercial |
$4,280.00
|
| Rate for Payer: Networks By Design Commercial |
$3,477.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,547.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,959.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.96
|
| Rate for Payer: Vantage Medical Group Senior |
$1,306.33
|
|
|
HC WART DESTRUCTION MULTIPLE
|
Facility
IP
|
$9,084.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
910400034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,180.16 |
| Max. Negotiated Rate |
$7,721.40 |
| Rate for Payer: Cash Price |
$4,087.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,633.60
|
| Rate for Payer: Galaxy Health WC |
$7,721.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,450.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,059.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,461.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,180.16
|
| Rate for Payer: Multiplan Commercial |
$7,267.20
|
| Rate for Payer: Networks By Design Commercial |
$5,904.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,721.40
|
|
|
HC WART DESTRUCTION MULTIPLE
|
Facility
OP
|
$9,084.00
|
|
|
Service Code
|
CPT 56515
|
| Hospital Charge Code |
910400034
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$232.98 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: BCBS Transplant Transplant |
$5,450.40
|
| Rate for Payer: Blue Shield of California Commercial |
$6,694.91
|
| Rate for Payer: Blue Shield of California EPN |
$5,305.06
|
| Rate for Payer: Cash Price |
$4,087.80
|
| Rate for Payer: Cash Price |
$4,087.80
|
| Rate for Payer: Cigna of CA HMO |
$5,813.76
|
| Rate for Payer: Cigna of CA PPO |
$6,722.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$7,721.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,450.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,813.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| Rate for Payer: IEHP Medi-Cal |
$3,691.15
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,691.15
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,059.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,180.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$7,267.20
|
| Rate for Payer: Networks By Design Commercial |
$5,904.60
|
| Rate for Payer: Prime Health Services Commercial |
$7,721.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,450.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,450.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,450.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,542.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,542.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,542.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC WART DESTRUCTION SINGLE
|
Facility
IP
|
$7,602.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,824.48 |
| Max. Negotiated Rate |
$6,461.70 |
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,040.80
|
| Rate for Payer: Galaxy Health WC |
$6,461.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,561.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,070.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,896.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,824.48
|
| Rate for Payer: Multiplan Commercial |
$6,081.60
|
| Rate for Payer: Networks By Design Commercial |
$4,941.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,461.70
|
|
|
HC WART DESTRUCTION SINGLE
|
Facility
OP
|
$7,602.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$342.80 |
| Max. Negotiated Rate |
$6,461.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,561.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,602.67
|
| Rate for Payer: Blue Shield of California EPN |
$4,439.57
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cigna of CA HMO |
$4,865.28
|
| Rate for Payer: Cigna of CA PPO |
$5,625.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$6,461.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,561.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,701.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,736.72
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,736.72
|
| Rate for Payer: IEHP Medi-Cal |
$3,691.15
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$3,691.15
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,070.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$342.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,824.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,870.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$6,081.60
|
| Rate for Payer: Networks By Design Commercial |
$4,941.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,461.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,561.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,561.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,561.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,801.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,801.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,801.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,801.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$562.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.21
|
| Rate for Payer: BCBS Transplant Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$145.35
|
| Rate for Payer: Blue Shield of California EPN |
$115.20
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Media |
$62.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$101.91
|
| Rate for Payer: Heritage Provider Network Transplant |
$101.91
|
| Rate for Payer: IEHP Medi-Cal |
$100.67
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$100.67
|
| Rate for Payer: IEHP Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
OP
|
$1,160.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$696.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: Cigna of CA PPO |
$858.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$870.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$817.05
|
| Rate for Payer: Heritage Provider Network Transplant |
$817.05
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$773.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$928.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$696.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$696.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$580.00
|
| Rate for Payer: United Healthcare All Other HMO |
$580.00
|
| Rate for Payer: United Healthcare HMO Rider |
$580.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$580.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
IP
|
$1,160.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$278.40 |
| Max. Negotiated Rate |
$986.00 |
| Rate for Payer: Cash Price |
$522.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.00
|
| Rate for Payer: Galaxy Health WC |
$986.00
|
| Rate for Payer: Global Benefits Group Commercial |
$696.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$773.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$441.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.40
|
| Rate for Payer: Multiplan Commercial |
$928.00
|
| Rate for Payer: Networks By Design Commercial |
$754.00
|
| Rate for Payer: Prime Health Services Commercial |
$986.00
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
IP
|
$995.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$238.80 |
| Max. Negotiated Rate |
$845.75 |
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.00
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
|
|
HC WEDGING OF CLUBFOOT CAST
|
Facility
OP
|
$995.00
|
|
|
Service Code
|
CPT 29750
|
| Hospital Charge Code |
900501517
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$335.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: BCBS Transplant Transplant |
$597.00
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cash Price |
$447.75
|
| Rate for Payer: Cigna of CA PPO |
$736.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$503.32
|
| Rate for Payer: Dignity Health Media |
$335.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.99
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$335.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$335.55
|
| Rate for Payer: Galaxy Health WC |
$845.75
|
| Rate for Payer: Global Benefits Group Commercial |
$597.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$746.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$550.30
|
| Rate for Payer: Heritage Provider Network Transplant |
$550.30
|
| Rate for Payer: IEHP Medi-Cal |
$936.00
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$335.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$335.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$449.64
|
| Rate for Payer: Multiplan Commercial |
$796.00
|
| Rate for Payer: Networks By Design Commercial |
$646.75
|
| Rate for Payer: Prime Health Services Commercial |
$845.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$597.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$497.50
|
| Rate for Payer: United Healthcare All Other HMO |
$497.50
|
| Rate for Payer: United Healthcare HMO Rider |
$497.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$497.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$503.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.10
|
| Rate for Payer: Vantage Medical Group Senior |
$335.55
|
|
|
HC WEEKLY PHYSICS
|
Facility
IP
|
$1,586.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$380.64 |
| Max. Negotiated Rate |
$1,348.10 |
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$634.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$634.40
|
| Rate for Payer: Galaxy Health WC |
$1,348.10
|
| Rate for Payer: Global Benefits Group Commercial |
$951.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$604.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.64
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Networks By Design Commercial |
$1,030.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.10
|
|
|
HC WEEKLY PHYSICS
|
Facility
OP
|
$1,586.00
|
|
|
Service Code
|
CPT 77336
|
| Hospital Charge Code |
904810813
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$104.65 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$332.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$686.29
|
| Rate for Payer: BCBS Transplant Transplant |
$951.60
|
| Rate for Payer: Blue Shield of California Commercial |
$937.33
|
| Rate for Payer: Blue Shield of California EPN |
$743.83
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cash Price |
$713.70
|
| Rate for Payer: Cigna of CA HMO |
$1,015.04
|
| Rate for Payer: Cigna of CA PPO |
$1,173.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,348.10
|
| Rate for Payer: Global Benefits Group Commercial |
$951.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,189.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$278.03
|
| Rate for Payer: Heritage Provider Network Transplant |
$278.03
|
| Rate for Payer: IEHP Medi-Cal |
$274.64
|
| Rate for Payer: IEHP Medi-Cal Transplant |
$274.64
|
| Rate for Payer: IEHP Medicare Advantage |
$169.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,268.80
|
| Rate for Payer: Networks By Design Commercial |
$1,030.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,348.10
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$951.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$951.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$133.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$95.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$104.40
|
| 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 |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO |
$111.36
|
| Rate for Payer: Cigna of CA PPO |
$128.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Media |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.60
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$130.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| 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 |
$147.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
HC WHEELCHAIR MGMT 15 MIN MCAL
|
Facility
IP
|
$174.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900400065
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$147.90 |
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.60
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
IP
|
$174.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$147.90 |
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.60
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
|
|
HC WHEELCHAIR MGMT 15MIN PT
|
Facility
OP
|
$174.00
|
|
|
Service Code
|
CPT 97542
|
| Hospital Charge Code |
900407542
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$41.76 |
| Max. Negotiated Rate |
$421.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$133.90
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$147.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$95.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$95.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$104.40
|
| 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 |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna of CA HMO |
$111.36
|
| Rate for Payer: Cigna of CA PPO |
$128.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$147.90
|
| Rate for Payer: Dignity Health Media |
$147.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$69.60
|
| Rate for Payer: Galaxy Health WC |
$147.90
|
| Rate for Payer: Global Benefits Group Commercial |
$104.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$130.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.76
|
| Rate for Payer: Multiplan Commercial |
$139.20
|
| Rate for Payer: Networks By Design Commercial |
$113.10
|
| Rate for Payer: Prime Health Services Commercial |
$147.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$104.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$104.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$104.40
|
| 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 |
$147.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.90
|
| Rate for Payer: Vantage Medical Group Senior |
$147.90
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
|
|
HC WHFO FING EXT WRIST SUPPORT
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300801
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$839.41 |
| Rate for Payer: Aetna of CA HMO/PPO |
$839.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$476.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$308.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$308.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: BCBS Transplant Transplant |
$336.00
|
| 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 |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: Cigna of CA HMO |
$358.40
|
| Rate for Payer: Cigna of CA PPO |
$414.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$476.00
|
| Rate for Payer: Dignity Health Media |
$476.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$279.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$336.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.00
|
| 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 |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$476.00
|
| Rate for Payer: Vantage Medical Group Senior |
$476.00
|
|
|
HC WHFO OPPENHEIMER OT
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT L3931
|
| Hospital Charge Code |
901300800
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Cash Price |
$252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.00
|
| Rate for Payer: Galaxy Health WC |
$476.00
|
| Rate for Payer: Global Benefits Group Commercial |
$336.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$373.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.40
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Networks By Design Commercial |
$364.00
|
| Rate for Payer: Prime Health Services Commercial |
$476.00
|
|
