|
HC SLITTING OF PREPUCE
|
Facility
|
IP
|
$8,572.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,714.40 |
| Max. Negotiated Rate |
$7,714.80 |
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,857.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,428.80
|
| Rate for Payer: Galaxy Health WC |
$7,286.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,143.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,714.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,717.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,265.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,714.40
|
| Rate for Payer: Multiplan Commercial |
$6,429.00
|
| Rate for Payer: Networks By Design Commercial |
$5,571.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,286.20
|
|
|
HC SLITTING OF PREPUCE
|
Facility
|
OP
|
$8,572.00
|
|
|
Service Code
|
CPT 54001
|
| Hospital Charge Code |
900501305
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$257.49 |
| Max. Negotiated Rate |
$7,714.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,143.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,391.79
|
| Rate for Payer: Blue Shield of California EPN |
$4,191.71
|
| Rate for Payer: Caremore Medicare Advantage |
$2,544.87
|
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Cash Price |
$3,857.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,857.60
|
| Rate for Payer: Cigna of CA HMO |
$5,486.08
|
| Rate for Payer: Cigna of CA PPO |
$6,343.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$7,286.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,143.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,714.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,429.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,717.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,714.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$6,429.00
|
| Rate for Payer: Networks By Design Commercial |
$5,571.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,286.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,143.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,143.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,286.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,286.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,286.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,286.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC SLOW ACTIVATION
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC SLOW ACTIVATION
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
900910078
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$53.29 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.29
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$6.01
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.02
|
| Rate for Payer: Dignity Health Media |
$6.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.11
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.01
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.01
|
| Rate for Payer: InnovAge PACE Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.05
|
| Rate for Payer: Multiplan Commercial |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| Rate for Payer: Prime Health Services Medicare |
$6.37
|
| Rate for Payer: Riverside University Health System MISP |
$6.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.87
|
| Rate for Payer: United Healthcare All Other HMO |
$4.87
|
| Rate for Payer: United Healthcare HMO Rider |
$4.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.61
|
| Rate for Payer: Vantage Medical Group Senior |
$6.01
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
OP
|
$26,273.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$5,254.60 |
| Max. Negotiated Rate |
$99,507.25 |
| Rate for Payer: Adventist Health Medi-Cal |
$17,259.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99,507.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25,889.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,985.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,259.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,134.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,191.51
|
| Rate for Payer: Blue Distinction Transplant |
$15,763.80
|
| Rate for Payer: Blue Shield of California Commercial |
$16,236.71
|
| Rate for Payer: Blue Shield of California EPN |
$12,768.68
|
| Rate for Payer: Caremore Medicare Advantage |
$17,259.85
|
| Rate for Payer: Cash Price |
$11,822.85
|
| Rate for Payer: Cash Price |
$11,822.85
|
| Rate for Payer: Central Health Plan Commercial |
$21,018.40
|
| Rate for Payer: Cigna of CA HMO |
$16,814.72
|
| Rate for Payer: Cigna of CA PPO |
$19,442.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25,889.78
|
| Rate for Payer: Dignity Health Media |
$17,259.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,985.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$23,300.80
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17,259.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$17,259.85
|
| Rate for Payer: Galaxy Health WC |
$22,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$15,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,645.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19,704.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28,306.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28,478.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17,259.85
|
| Rate for Payer: InnovAge PACE Commercial |
$25,889.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,524.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,945.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,259.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,254.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,128.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,128.20
|
| Rate for Payer: Multiplan Commercial |
$19,704.75
|
| Rate for Payer: Networks By Design Commercial |
$17,077.45
|
| Rate for Payer: Prime Health Services Commercial |
$22,332.05
|
| Rate for Payer: Prime Health Services Medicare |
$18,295.44
|
| Rate for Payer: Riverside University Health System MISP |
$18,985.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,763.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15,763.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,136.50
|
| Rate for Payer: United Healthcare All Other HMO |
$13,136.50
|
| Rate for Payer: United Healthcare HMO Rider |
$13,136.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,136.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25,889.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,985.84
|
| Rate for Payer: Vantage Medical Group Senior |
$17,259.85
|
|
|
HC SM153 LEXIDRONAMM 50 MCI QUADR
|
Facility
|
IP
|
$26,273.00
|
|
|
Service Code
|
CPT A9604
|
| Hospital Charge Code |
909301571
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$5,254.60 |
| Max. Negotiated Rate |
$23,645.70 |
| Rate for Payer: Blue Shield of California Commercial |
$19,704.75
|
| Rate for Payer: Blue Shield of California EPN |
$14,029.78
|
| Rate for Payer: Cash Price |
$11,822.85
|
| Rate for Payer: Central Health Plan Commercial |
$21,018.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,509.20
|
| Rate for Payer: Galaxy Health WC |
$22,332.05
|
| Rate for Payer: Global Benefits Group Commercial |
$15,763.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,645.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,524.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,010.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,254.60
|
| Rate for Payer: Multiplan Commercial |
$19,704.75
|
| Rate for Payer: Networks By Design Commercial |
$17,077.45
|
| Rate for Payer: Prime Health Services Commercial |
$22,332.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,920.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9,689.48
|
| Rate for Payer: United Healthcare HMO Rider |
$9,479.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,670.09
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
IP
|
$1,585.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$317.00 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Cash Price |
$713.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,268.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$634.00
|
| Rate for Payer: Galaxy Health WC |
$1,347.25
|
| Rate for Payer: Global Benefits Group Commercial |
$951.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,426.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$603.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.00
|
| Rate for Payer: Multiplan Commercial |
$1,188.75
|
| Rate for Payer: Networks By Design Commercial |
$1,030.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,347.25
|
|
|
HC SMALL BOWEL SNGL CNTRST
|
Facility
|
OP
|
$1,585.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
909001828
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.78 |
| Max. Negotiated Rate |
$1,426.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$468.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$271.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.84
|
| Rate for Payer: Blue Distinction Transplant |
$951.00
|
| Rate for Payer: Blue Shield of California Commercial |
$979.53
|
| Rate for Payer: Blue Shield of California EPN |
$770.31
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$713.25
|
| Rate for Payer: Cash Price |
$713.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,268.00
|
| Rate for Payer: Cigna of CA HMO |
$1,014.40
|
| Rate for Payer: Cigna of CA PPO |
$1,172.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,347.25
|
| Rate for Payer: Global Benefits Group Commercial |
$951.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,426.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,188.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,057.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,188.75
|
| Rate for Payer: Networks By Design Commercial |
$1,030.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,347.25
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$951.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$951.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC SMIC/ID
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$26.10 |
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.60
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
|
|
HC SMIC/ID
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.80 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.63
|
| Rate for Payer: Blue Distinction Transplant |
$17.40
|
| Rate for Payer: Blue Shield of California Commercial |
$17.92
|
| Rate for Payer: Blue Shield of California EPN |
$14.09
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Cash Price |
$13.05
|
| Rate for Payer: Central Health Plan Commercial |
$23.20
|
| Rate for Payer: Cigna of CA HMO |
$18.56
|
| Rate for Payer: Cigna of CA PPO |
$21.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$24.65
|
| Rate for Payer: Global Benefits Group Commercial |
$17.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$26.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$21.75
|
| Rate for Payer: Networks By Design Commercial |
$18.85
|
| Rate for Payer: Prime Health Services Commercial |
$24.65
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC SMOKING CESSATION 3 - 10 MIN
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201910
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Central Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.40
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
|
|
HC SMOKING CESSATION 3 - 10 MIN
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201910
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.85
|
| Rate for Payer: Blue Distinction Transplant |
$48.60
|
| Rate for Payer: Blue Shield of California Commercial |
$50.95
|
| Rate for Payer: Blue Shield of California EPN |
$39.61
|
| Rate for Payer: Caremore Medicare Advantage |
$35.85
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Cash Price |
$36.45
|
| Rate for Payer: Central Health Plan Commercial |
$64.80
|
| Rate for Payer: Cigna of CA HMO |
$51.84
|
| Rate for Payer: Cigna of CA PPO |
$59.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Media |
$35.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$60.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.85
|
| Rate for Payer: InnovAge PACE Commercial |
$53.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.04
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
| Rate for Payer: Prime Health Services Medicare |
$38.00
|
| Rate for Payer: Riverside University Health System MISP |
$39.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC SMOKING CESSATION GT 10 MIN
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
905199407
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.99
|
| Rate for Payer: Blue Distinction Transplant |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$55.35
|
| Rate for Payer: Blue Shield of California EPN |
$43.03
|
| Rate for Payer: Caremore Medicare Advantage |
$35.85
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Media |
$35.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.85
|
| Rate for Payer: InnovAge PACE Commercial |
$53.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.04
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$38.00
|
| Rate for Payer: Riverside University Health System MISP |
$39.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC SMOKING CESSATION GT 10 MIN
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
905199407
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC SMOKING/TOBACCO INTENS >10 MIN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
900201907
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.99
|
| Rate for Payer: Blue Distinction Transplant |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$83.03
|
| Rate for Payer: Blue Shield of California EPN |
$64.55
|
| Rate for Payer: Caremore Medicare Advantage |
$35.85
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$84.48
|
| Rate for Payer: Cigna of CA PPO |
$97.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Media |
$35.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$99.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.85
|
| Rate for Payer: InnovAge PACE Commercial |
$53.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.04
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Prime Health Services Medicare |
$38.00
|
| Rate for Payer: Riverside University Health System MISP |
$39.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.99
|
| Rate for Payer: Blue Distinction Transplant |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$55.35
|
| Rate for Payer: Blue Shield of California EPN |
$43.03
|
| Rate for Payer: Caremore Medicare Advantage |
$35.85
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.78
|
| Rate for Payer: Dignity Health Media |
$35.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.85
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.85
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$58.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.85
|
| Rate for Payer: InnovAge PACE Commercial |
$53.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.04
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$38.00
|
| Rate for Payer: Riverside University Health System MISP |
$39.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.44
|
| Rate for Payer: Vantage Medical Group Senior |
$35.85
|
|
|
HC SMOKING/TOBACCO VISIT 3-10 MIN
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
900201906
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC SM (SMITH) ANTIBODY
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
900913523
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$135.13 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$110.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.13
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$17.93
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Media |
$17.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.93
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$29.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: InnovAge PACE Commercial |
$26.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$19.01
|
| Rate for Payer: Riverside University Health System MISP |
$19.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
OP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.90 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$359.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$316.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$386.38
|
| Rate for Payer: Blue Distinction Transplant |
$392.40
|
| Rate for Payer: Blue Shield of California Commercial |
$490.50
|
| Rate for Payer: Blue Shield of California EPN |
$355.78
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.90
|
| Rate for Payer: Dignity Health Media |
$555.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$555.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$490.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$228.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$268.14
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: Riverside University Health System MISP |
$261.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$392.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$392.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$327.00
|
| Rate for Payer: United Healthcare All Other HMO |
$327.00
|
| Rate for Payer: United Healthcare HMO Rider |
$327.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$555.90
|
| Rate for Payer: Vantage Medical Group Senior |
$555.90
|
|
|
HC SNGL AXIS ANKLE/FLEXIBLE KEEL
|
Facility
|
IP
|
$654.00
|
|
|
Service Code
|
CPT L5975
|
| Hospital Charge Code |
905355975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.80 |
| Max. Negotiated Rate |
$588.60 |
| Rate for Payer: Blue Shield of California EPN |
$349.24
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Central Health Plan Commercial |
$523.20
|
| Rate for Payer: Cigna of CA HMO |
$457.80
|
| Rate for Payer: Cigna of CA PPO |
$457.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$261.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$261.60
|
| Rate for Payer: Galaxy Health WC |
$555.90
|
| Rate for Payer: Global Benefits Group Commercial |
$392.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$588.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.80
|
| Rate for Payer: Multiplan Commercial |
$490.50
|
| Rate for Payer: Networks By Design Commercial |
$327.00
|
| Rate for Payer: Prime Health Services Commercial |
$555.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.95
|
| Rate for Payer: United Healthcare All Other HMO |
$241.20
|
| Rate for Payer: United Healthcare HMO Rider |
$235.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.82
|
|
|
HC SNRE ENDOS 2.3MMX240CM
|
Facility
|
IP
|
$163.88
|
|
| Hospital Charge Code |
900100349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.55
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
|
|
HC SNRE ENDOS 2.3MMX240CM
|
Facility
|
OP
|
$163.88
|
|
| Hospital Charge Code |
900100349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$147.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$99.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$139.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.82
|
| Rate for Payer: Blue Distinction Transplant |
$98.33
|
| Rate for Payer: Blue Shield of California Commercial |
$103.08
|
| Rate for Payer: Blue Shield of California EPN |
$80.14
|
| Rate for Payer: Cash Price |
$73.75
|
| Rate for Payer: Central Health Plan Commercial |
$131.10
|
| Rate for Payer: Cigna of CA HMO |
$104.88
|
| Rate for Payer: Cigna of CA PPO |
$121.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$139.30
|
| Rate for Payer: Dignity Health Media |
$139.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$139.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$65.55
|
| Rate for Payer: Galaxy Health WC |
$139.30
|
| Rate for Payer: Global Benefits Group Commercial |
$98.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$147.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$122.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$109.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.78
|
| Rate for Payer: Multiplan Commercial |
$122.91
|
| Rate for Payer: Networks By Design Commercial |
$106.52
|
| Rate for Payer: Prime Health Services Commercial |
$139.30
|
| Rate for Payer: Riverside University Health System MISP |
$65.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$98.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$98.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.94
|
| Rate for Payer: United Healthcare All Other HMO |
$81.94
|
| Rate for Payer: United Healthcare HMO Rider |
$81.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$139.30
|
| Rate for Payer: Vantage Medical Group Senior |
$139.30
|
|
|
HC SNRE POLYPECTOMY 3X4.5CM
|
Facility
|
IP
|
$522.01
|
|
| Hospital Charge Code |
900100353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.81 |
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Central Health Plan Commercial |
$417.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.71
|
| Rate for Payer: Global Benefits Group Commercial |
$313.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$391.51
|
| Rate for Payer: Networks By Design Commercial |
$339.31
|
| Rate for Payer: Prime Health Services Commercial |
$443.71
|
|
