|
HC SNRE POLYPECTOMY 3X4.5CM
|
Facility
OP
|
$522.01
|
|
| Hospital Charge Code |
900100353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$317.02
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$443.71
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$287.11
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$287.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$252.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.40
|
| Rate for Payer: BCBS Transplant Transplant |
$313.21
|
| Rate for Payer: Blue Shield of California Commercial |
$328.34
|
| Rate for Payer: Blue Shield of California EPN |
$255.26
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Central Health Plan Commercial |
$417.61
|
| Rate for Payer: Cigna of CA HMO |
$334.09
|
| Rate for Payer: Cigna of CA PPO |
$386.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$443.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$391.51
|
| Rate for Payer: IEHP medi-cal |
$182.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.18
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$313.21
|
| Rate for Payer: Riverside University Health MISP |
$208.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$313.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$313.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$261.00
|
| Rate for Payer: United Healthcare HMO Rider |
$261.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$261.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$443.71
|
| Rate for Payer: Vantage Medical Group Senior |
$443.71
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
OP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.54 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.47
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.49
|
| Rate for Payer: BCBS Transplant Transplant |
$35.46
|
| Rate for Payer: Blue Shield of California Commercial |
$36.52
|
| Rate for Payer: Blue Shield of California EPN |
$28.72
|
| Rate for Payer: Caremore Medicare Advantage |
$13.01
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Central Health Plan Commercial |
$47.28
|
| Rate for Payer: Cigna of CA HMO |
$37.82
|
| Rate for Payer: Cigna of CA PPO |
$43.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.01
|
| Rate for Payer: Galaxy Health WC |
$50.24
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.19
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.32
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.34
|
| Rate for Payer: IEHP medi-cal |
$21.47
|
| Rate for Payer: IEHP Medicare Advantage |
$13.01
|
| Rate for Payer: Innovage PACE Commercial |
$19.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.43
|
| Rate for Payer: Multiplan Commercial |
$44.32
|
| Rate for Payer: Networks By Design Commercial |
$38.42
|
| Rate for Payer: Prime Health Services Commercial |
$50.24
|
| Rate for Payer: Prime Health Services Medicare |
$13.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35.46
|
| Rate for Payer: Riverside University Health MISP |
$14.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.54
|
| Rate for Payer: United Healthcare All Other HMO |
$10.54
|
| Rate for Payer: United Healthcare HMO Rider |
$10.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13.01
|
|
|
HC SOA 55284 CYSTICER AB IGG
|
Facility
IP
|
$59.10
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
900914796
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$11.82 |
| Max. Negotiated Rate |
$53.19 |
| Rate for Payer: Cash Price |
$26.60
|
| Rate for Payer: Central Health Plan Commercial |
$47.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.64
|
| Rate for Payer: Galaxy Health WC |
$50.24
|
| Rate for Payer: Global Benefits Group Commercial |
$35.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$44.32
|
| Rate for Payer: Networks By Design Commercial |
$38.42
|
| Rate for Payer: Prime Health Services Commercial |
$50.24
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
IP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$675.00 |
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$300.00
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
|
|
HC SOA 837 CEL MODY8 MUT
|
Facility
OP
|
$750.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
900914773
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$150.00 |
| Max. Negotiated Rate |
$1,327.96 |
| Rate for Payer: Adventist Health Medi-Cal |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$368.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$185.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,088.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,327.96
|
| Rate for Payer: BCBS Transplant Transplant |
$450.00
|
| Rate for Payer: Blue Shield of California Commercial |
$463.50
|
| Rate for Payer: Blue Shield of California EPN |
$364.50
|
| Rate for Payer: Caremore Medicare Advantage |
$185.20
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Central Health Plan Commercial |
$600.00
|
| Rate for Payer: Cigna of CA HMO |
$480.00
|
| Rate for Payer: Cigna of CA PPO |
$555.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$277.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$250.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$185.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$185.20
|
| Rate for Payer: Galaxy Health WC |
$637.50
|
| Rate for Payer: Global Benefits Group Commercial |
$450.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$675.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$562.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$303.73
|
| Rate for Payer: IEHP medi-cal |
$305.58
|
| Rate for Payer: IEHP Medicare Advantage |
$185.20
|
| Rate for Payer: Innovage PACE Commercial |
$277.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$500.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$150.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$248.17
|
| Rate for Payer: Multiplan Commercial |
$562.50
|
| Rate for Payer: Networks By Design Commercial |
$487.50
|
| Rate for Payer: Prime Health Services Commercial |
$637.50
|
| Rate for Payer: Prime Health Services Medicare |
$196.31
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: Riverside University Health MISP |
$203.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$450.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$450.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.01
|
| Rate for Payer: United Healthcare All Other HMO |
$150.01
|
| Rate for Payer: United Healthcare HMO Rider |
$150.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$277.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$203.72
|
| Rate for Payer: Vantage Medical Group Senior |
$185.20
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81405
|
Facility
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
900914774
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$2,091.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$301.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$644.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$301.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,714.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,091.26
|
| Rate for Payer: BCBS Transplant Transplant |
$632.25
|
| Rate for Payer: Blue Shield of California Commercial |
$651.22
|
| Rate for Payer: Blue Shield of California EPN |
$512.12
|
| Rate for Payer: Caremore Medicare Advantage |
$301.35
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$452.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$301.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$301.35
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$790.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$494.21
|
| Rate for Payer: IEHP medi-cal |
$497.23
|
| Rate for Payer: IEHP Medicare Advantage |
$301.35
|
| Rate for Payer: Innovage PACE Commercial |
$452.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$301.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$403.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$403.81
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Prime Health Services Medicare |
$319.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: Riverside University Health MISP |
$331.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$244.10
|
| Rate for Payer: United Healthcare All Other HMO |
$244.10
|
| Rate for Payer: United Healthcare HMO Rider |
$244.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$244.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$452.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$331.48
|
| Rate for Payer: Vantage Medical Group Senior |
$301.35
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81406
|
Facility
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$2,133.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$282.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$366.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$282.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,748.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,133.20
|
| Rate for Payer: BCBS Transplant Transplant |
$632.25
|
| Rate for Payer: Blue Shield of California Commercial |
$651.22
|
| Rate for Payer: Blue Shield of California EPN |
$512.12
|
| Rate for Payer: Caremore Medicare Advantage |
$282.88
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$282.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$282.88
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$790.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$463.92
|
| Rate for Payer: IEHP medi-cal |
$466.75
|
| Rate for Payer: IEHP Medicare Advantage |
$282.88
|
| Rate for Payer: Innovage PACE Commercial |
$424.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$379.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$379.06
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Prime Health Services Medicare |
$299.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: Riverside University Health MISP |
$311.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$229.13
|
| Rate for Payer: United Healthcare All Other HMO |
$229.13
|
| Rate for Payer: United Healthcare HMO Rider |
$229.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$424.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.17
|
| Rate for Payer: Vantage Medical Group Senior |
$282.88
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$579.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$579.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$510.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$622.56
|
| Rate for Payer: BCBS Transplant Transplant |
$632.25
|
| Rate for Payer: Blue Shield of California Commercial |
$651.22
|
| Rate for Payer: Blue Shield of California EPN |
$512.12
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$790.31
|
| Rate for Payer: IEHP medi-cal |
$368.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: Riverside University Health MISP |
$421.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.88
|
| Rate for Payer: United Healthcare All Other HMO |
$526.88
|
| Rate for Payer: United Healthcare HMO Rider |
$526.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.69
|
| Rate for Payer: Vantage Medical Group Senior |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$948.38 |
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Central Health Plan Commercial |
$843.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$948.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.75
|
| Rate for Payer: Multiplan Commercial |
$790.31
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
905353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$223.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$223.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$116.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.25
|
| Rate for Payer: BCBS Transplant Transplant |
$127.20
|
| Rate for Payer: Blue Shield of California Commercial |
$159.00
|
| Rate for Payer: Blue Shield of California EPN |
$115.33
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$159.00
|
| Rate for Payer: IEHP medi-cal |
$74.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.92
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Riverside University Health MISP |
$84.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$106.00
|
| Rate for Payer: United Healthcare All Other HMO |
$106.00
|
| Rate for Payer: United Healthcare HMO Rider |
$106.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$106.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
905353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Blue Shield of California EPN |
$113.21
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
OP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
905353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$240.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$240.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$72.60
|
| 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: BCBS Transplant Transplant |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$99.00
|
| Rate for Payer: Blue Shield of California EPN |
$71.81
|
| 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 |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$99.00
|
| Rate for Payer: IEHP medi-cal |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health MISP |
$52.80
|
| 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 |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
IP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
905353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Blue Shield of California EPN |
$70.49
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC SO ACROMIO/CLAVICULAR
|
Facility
IP
|
$249.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901309109
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$224.10 |
| Rate for Payer: Blue Shield of California EPN |
$132.97
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.80
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
|
|
HC SO ACROMIO/CLAVICULAR
|
Facility
OP
|
$249.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
901309109
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.15 |
| Max. Negotiated Rate |
$246.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$246.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$136.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.11
|
| Rate for Payer: BCBS Transplant Transplant |
$149.40
|
| Rate for Payer: Blue Shield of California Commercial |
$186.75
|
| Rate for Payer: Blue Shield of California EPN |
$135.46
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Central Health Plan Commercial |
$199.20
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$224.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$186.75
|
| Rate for Payer: IEHP medi-cal |
$87.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.09
|
| Rate for Payer: Multiplan Commercial |
$186.75
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Riverside University Health MISP |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.50
|
| Rate for Payer: United Healthcare All Other HMO |
$124.50
|
| Rate for Payer: United Healthcare HMO Rider |
$124.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC SO AC TYPE
|
Facility
IP
|
$410.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
905353670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Blue Shield of California EPN |
$218.94
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
|
|
HC SO AC TYPE
|
Facility
OP
|
$410.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
905353670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.50 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$246.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$225.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$198.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.23
|
| Rate for Payer: BCBS Transplant Transplant |
$246.00
|
| Rate for Payer: Blue Shield of California Commercial |
$307.50
|
| Rate for Payer: Blue Shield of California EPN |
$223.04
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$307.50
|
| Rate for Payer: IEHP medi-cal |
$143.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.10
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Riverside University Health MISP |
$164.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$205.00
|
| Rate for Payer: United Healthcare All Other HMO |
$205.00
|
| Rate for Payer: United Healthcare HMO Rider |
$205.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$205.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC SO AIRPLANE 2/2O JOINT CF
|
Facility
IP
|
$1,960.00
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
915353674
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$1,764.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,046.64
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.00
|
| Rate for Payer: Cigna of CA HMO |
$1,372.00
|
| Rate for Payer: Cigna of CA PPO |
$1,372.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.00
|
| Rate for Payer: Galaxy Health WC |
$1,666.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.00
|
| Rate for Payer: Multiplan Commercial |
$1,470.00
|
| Rate for Payer: Networks By Design Commercial |
$980.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.00
|
|
|
HC SO AIRPLANE 2/2O JOINT CF
|
Facility
OP
|
$1,960.00
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
915353674
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$686.00 |
| Max. Negotiated Rate |
$4,266.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,266.95
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,666.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,078.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,078.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$949.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,157.97
|
| Rate for Payer: BCBS Transplant Transplant |
$1,176.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,470.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,066.24
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Cash Price |
$882.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.00
|
| Rate for Payer: Cigna of CA HMO |
$1,372.00
|
| Rate for Payer: Cigna of CA PPO |
$1,372.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,666.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.00
|
| Rate for Payer: Galaxy Health WC |
$1,666.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,470.00
|
| Rate for Payer: IEHP medi-cal |
$686.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$803.60
|
| Rate for Payer: Multiplan Commercial |
$1,470.00
|
| Rate for Payer: Networks By Design Commercial |
$980.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.00
|
| Rate for Payer: Riverside University Health MISP |
$784.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$980.00
|
| Rate for Payer: United Healthcare All Other HMO |
$980.00
|
| Rate for Payer: United Healthcare HMO Rider |
$980.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$980.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,666.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,666.00
|
|
|
HC SO CAP DESIGN W/O JNTS CF
|
Facility
OP
|
$1,345.00
|
|
|
Service Code
|
CPT L3671
|
| Hospital Charge Code |
905353671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$470.75 |
| Max. Negotiated Rate |
$3,252.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,252.66
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,143.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$739.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$739.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$651.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$794.63
|
| Rate for Payer: BCBS Transplant Transplant |
$807.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.75
|
| Rate for Payer: Blue Shield of California EPN |
$731.68
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.00
|
| Rate for Payer: Cigna of CA HMO |
$941.50
|
| Rate for Payer: Cigna of CA PPO |
$941.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,143.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$538.00
|
| Rate for Payer: Galaxy Health WC |
$1,143.25
|
| Rate for Payer: Global Benefits Group Commercial |
$807.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,210.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,008.75
|
| Rate for Payer: IEHP medi-cal |
$470.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$551.45
|
| Rate for Payer: Multiplan Commercial |
$1,008.75
|
| Rate for Payer: Networks By Design Commercial |
$672.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.25
|
| Rate for Payer: Riverside University Health MISP |
$538.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$672.50
|
| Rate for Payer: United Healthcare All Other HMO |
$672.50
|
| Rate for Payer: United Healthcare HMO Rider |
$672.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$672.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,143.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,143.25
|
|
|
HC SO CAP DESIGN W/O JNTS CF
|
Facility
IP
|
$1,345.00
|
|
|
Service Code
|
CPT L3671
|
| Hospital Charge Code |
905353671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.00 |
| Max. Negotiated Rate |
$1,210.50 |
| Rate for Payer: Blue Shield of California EPN |
$718.23
|
| Rate for Payer: Cash Price |
$605.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.00
|
| Rate for Payer: Cigna of CA HMO |
$941.50
|
| Rate for Payer: Cigna of CA PPO |
$941.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$538.00
|
| Rate for Payer: Galaxy Health WC |
$1,143.25
|
| Rate for Payer: Global Benefits Group Commercial |
$807.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,210.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.00
|
| Rate for Payer: Multiplan Commercial |
$1,008.75
|
| Rate for Payer: Networks By Design Commercial |
$672.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.25
|
|
|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
IP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$339.80 |
| Max. Negotiated Rate |
$1,529.10 |
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,359.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.60
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,529.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,133.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.80
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
|
|
HC SOCC FANCONI COMPLEM ASSAY
|
Facility
OP
|
$1,699.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914675
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$276.11 |
| Max. Negotiated Rate |
$1,529.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$276.11
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,444.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$934.45
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$934.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$822.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,003.77
|
| Rate for Payer: BCBS Transplant Transplant |
$1,019.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,049.98
|
| Rate for Payer: Blue Shield of California EPN |
$825.71
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Cash Price |
$764.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,359.20
|
| Rate for Payer: Cigna of CA HMO |
$1,087.36
|
| Rate for Payer: Cigna of CA PPO |
$1,257.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,444.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$679.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$679.60
|
| Rate for Payer: Galaxy Health WC |
$1,444.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,019.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,529.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,274.25
|
| Rate for Payer: IEHP medi-cal |
$594.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,133.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.80
|
| Rate for Payer: Multiplan Commercial |
$1,274.25
|
| Rate for Payer: Networks By Design Commercial |
$1,104.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,444.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,019.40
|
| Rate for Payer: Riverside University Health MISP |
$679.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,019.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,019.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$849.50
|
| Rate for Payer: United Healthcare All Other HMO |
$849.50
|
| Rate for Payer: United Healthcare HMO Rider |
$849.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$849.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,444.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,444.15
|
|
