|
HC SURGICAL PROCEDURE
|
Facility
OP
|
$13,155.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,631.00 |
| Max. Negotiated Rate |
$11,839.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,989.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11,181.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7,235.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7,235.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,369.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,771.97
|
| Rate for Payer: BCBS Transplant Transplant |
$7,893.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$5,919.75
|
| Rate for Payer: Cash Price |
$5,919.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,524.00
|
| Rate for Payer: Cigna of CA PPO |
$9,734.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,181.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,262.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,262.00
|
| Rate for Payer: Galaxy Health WC |
$11,181.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,893.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,839.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$9,866.25
|
| Rate for Payer: IEHP medi-cal |
$4,604.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,774.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,631.00
|
| Rate for Payer: Multiplan Commercial |
$9,866.25
|
| Rate for Payer: Networks By Design Commercial |
$8,550.75
|
| Rate for Payer: Prime Health Services Commercial |
$11,181.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7,893.00
|
| Rate for Payer: Riverside University Health MISP |
$5,262.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,893.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,577.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,577.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,577.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,577.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,181.75
|
| Rate for Payer: Vantage Medical Group Senior |
$11,181.75
|
|
|
HC SURGICAL SPECIMEN
|
Facility
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC SURGICAL SPECIMEN
|
Facility
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.95
|
| Rate for Payer: BCBS Transplant Transplant |
$987.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.23
|
| Rate for Payer: Blue Shield of California EPN |
$799.96
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,234.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: IEHP medi-cal |
$1,137.31
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Innovage PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$987.60
|
| Rate for Payer: Riverside University Health MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC SURGICAL SPECIMEN
|
Facility
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
|
HC SURGICAL SPECIMEN
|
Facility
OP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
906601168
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$108,812.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$689.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$689.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$972.46
|
| Rate for Payer: BCBS Transplant Transplant |
$987.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.23
|
| Rate for Payer: Blue Shield of California EPN |
$799.96
|
| Rate for Payer: Caremore Medicare Advantage |
$689.28
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Cash Price |
$740.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: Cigna of CA HMO |
$1,053.44
|
| Rate for Payer: Cigna of CA PPO |
$1,218.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$689.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$689.28
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,234.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,130.42
|
| Rate for Payer: IEHP medi-cal |
$1,137.31
|
| Rate for Payer: IEHP Medicare Advantage |
$689.28
|
| Rate for Payer: Innovage PACE Commercial |
$1,033.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$689.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$923.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$923.64
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
| Rate for Payer: Prime Health Services Medicare |
$730.64
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$987.60
|
| Rate for Payer: Riverside University Health MISP |
$758.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$987.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$987.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108,812.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$758.21
|
| Rate for Payer: Vantage Medical Group Senior |
$689.28
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
IP
|
$1,657.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$1,491.30 |
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,325.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$662.80
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,491.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.40
|
| Rate for Payer: Multiplan Commercial |
$1,242.75
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
|
|
HC SURGPREP FC/HD/HND/FT/G 1ST 100 SQ CM
|
Facility
OP
|
$1,657.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
900101497
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$331.40 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$784.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$994.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,042.25
|
| Rate for Payer: Blue Shield of California EPN |
$810.27
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Cash Price |
$745.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,325.60
|
| Rate for Payer: Cigna of CA HMO |
$1,060.48
|
| Rate for Payer: Cigna of CA PPO |
$1,226.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,059.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$784.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.71
|
| Rate for Payer: Galaxy Health WC |
$1,408.45
|
| Rate for Payer: Global Benefits Group Commercial |
$994.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,491.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,242.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: IEHP medi-cal |
$1,294.77
|
| Rate for Payer: IEHP Medicare Advantage |
$784.71
|
| Rate for Payer: Innovage PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,105.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$331.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,051.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,051.51
|
| Rate for Payer: Multiplan Commercial |
$1,242.75
|
| Rate for Payer: Networks By Design Commercial |
$1,077.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,408.45
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$994.20
|
| Rate for Payer: Riverside University Health MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$994.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$994.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$828.50
|
| Rate for Payer: United Healthcare All Other HMO |
$828.50
|
| Rate for Payer: United Healthcare HMO Rider |
$828.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$828.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Vantage Medical Group Senior |
$784.71
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
IP
|
$828.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
|
|
HC SURGPREP FC/HD/HND/FT/G EACH ADDL 100 SQ CM
|
Facility
OP
|
$828.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
900101498
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$165.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$455.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$496.80
|
| Rate for Payer: Blue Shield of California Commercial |
$520.81
|
| Rate for Payer: Blue Shield of California EPN |
$404.89
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Central Health Plan Commercial |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$529.92
|
| Rate for Payer: Cigna of CA PPO |
$612.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$703.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$331.20
|
| Rate for Payer: Galaxy Health WC |
$703.80
|
| Rate for Payer: Global Benefits Group Commercial |
$496.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$745.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$621.00
|
| Rate for Payer: IEHP medi-cal |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$621.00
|
| Rate for Payer: Networks By Design Commercial |
$538.20
|
| Rate for Payer: Prime Health Services Commercial |
$703.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: Riverside University Health MISP |
$331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$414.00
|
| Rate for Payer: United Healthcare All Other HMO |
$414.00
|
| Rate for Payer: United Healthcare HMO Rider |
$414.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$414.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$703.80
|
| Rate for Payer: Vantage Medical Group Senior |
$703.80
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
OP
|
$5,410.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,082.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,246.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,402.89
|
| Rate for Payer: Blue Shield of California EPN |
$2,645.49
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,328.00
|
| Rate for Payer: Cigna of CA HMO |
$3,462.40
|
| Rate for Payer: Cigna of CA PPO |
$4,003.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,598.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,869.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,057.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,608.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$4,057.50
|
| Rate for Payer: Networks By Design Commercial |
$3,516.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,598.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,246.00
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,705.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,705.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,705.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,705.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC SURGPREP TRUNK/ARM/LEG 1ST 100 SQ CM
|
Facility
IP
|
$5,410.00
|
|
|
Service Code
|
CPT 15002
|
| Hospital Charge Code |
900101495
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$1,082.00 |
| Max. Negotiated Rate |
$4,869.00 |
| Rate for Payer: Cash Price |
$2,434.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,328.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,164.00
|
| Rate for Payer: Galaxy Health WC |
$4,598.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,869.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,608.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.00
|
| Rate for Payer: Multiplan Commercial |
$4,057.50
|
| Rate for Payer: Networks By Design Commercial |
$3,516.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,598.50
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
IP
|
$2,705.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$2,434.50 |
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
|
|
HC SURGPREP TRUNK/ARM/LEG EACH ADDL 100 SQ CM
|
Facility
OP
|
$2,705.00
|
|
|
Service Code
|
CPT 15003
|
| Hospital Charge Code |
900101496
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$541.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,299.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,487.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,487.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,623.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,701.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,322.74
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Cash Price |
$1,217.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,164.00
|
| Rate for Payer: Cigna of CA HMO |
$1,731.20
|
| Rate for Payer: Cigna of CA PPO |
$2,001.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,299.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,082.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,082.00
|
| Rate for Payer: Galaxy Health WC |
$2,299.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,623.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,434.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,028.75
|
| Rate for Payer: IEHP medi-cal |
$946.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,804.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$541.00
|
| Rate for Payer: Multiplan Commercial |
$2,028.75
|
| Rate for Payer: Networks By Design Commercial |
$1,758.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,299.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,623.00
|
| Rate for Payer: Riverside University Health MISP |
$1,082.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,623.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,623.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,352.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,352.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,352.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,299.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,299.25
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.44
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.71
|
| Rate for Payer: BCBS Transplant Transplant |
$46.80
|
| Rate for Payer: Blue Shield of California Commercial |
$48.20
|
| Rate for Payer: Blue Shield of California EPN |
$37.91
|
| Rate for Payer: Caremore Medicare Advantage |
$8.65
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Cash Price |
$35.10
|
| Rate for Payer: Central Health Plan Commercial |
$62.40
|
| Rate for Payer: Cigna of CA HMO |
$49.92
|
| Rate for Payer: Cigna of CA PPO |
$57.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.65
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$66.30
|
| Rate for Payer: Global Benefits Group Commercial |
$46.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$70.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$58.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.19
|
| Rate for Payer: IEHP medi-cal |
$14.27
|
| Rate for Payer: IEHP Medicare Advantage |
$8.65
|
| Rate for Payer: Innovage PACE Commercial |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$58.50
|
| Rate for Payer: Networks By Design Commercial |
$50.70
|
| Rate for Payer: Prime Health Services Commercial |
$66.30
|
| Rate for Payer: Prime Health Services Medicare |
$9.17
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$9.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.80 |
| Max. Negotiated Rate |
$98.10 |
| Rate for Payer: Cash Price |
$49.05
|
| Rate for Payer: Central Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.60
|
| Rate for Payer: Galaxy Health WC |
$92.65
|
| Rate for Payer: Global Benefits Group Commercial |
$65.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$98.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.80
|
| Rate for Payer: Multiplan Commercial |
$81.75
|
| Rate for Payer: Networks By Design Commercial |
$70.85
|
| Rate for Payer: Prime Health Services Commercial |
$92.65
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
905352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$135.00 |
| Rate for Payer: Blue Shield of California EPN |
$80.10
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.00
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC SUSPENSION SLEEVE KO ADDITION LE
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
CPT L2397
|
| Hospital Charge Code |
905352397
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$52.50 |
| Max. Negotiated Rate |
$466.62 |
| Rate for Payer: Aetna of CA HMO/PPO |
$466.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.62
|
| Rate for Payer: BCBS Transplant Transplant |
$90.00
|
| Rate for Payer: Blue Shield of California Commercial |
$112.50
|
| Rate for Payer: Blue Shield of California EPN |
$81.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Central Health Plan Commercial |
$120.00
|
| Rate for Payer: Cigna of CA HMO |
$105.00
|
| Rate for Payer: Cigna of CA PPO |
$105.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$112.50
|
| Rate for Payer: IEHP medi-cal |
$52.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$112.50
|
| Rate for Payer: Networks By Design Commercial |
$75.00
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Riverside University Health MISP |
$60.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$75.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC SUTR/STPL RMVL REQUIRING ANES
|
Facility
IP
|
$6,026.00
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
907201033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,205.20 |
| Max. Negotiated Rate |
$5,423.40 |
| Rate for Payer: Cash Price |
$2,711.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,820.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,410.40
|
| Rate for Payer: Galaxy Health WC |
$5,122.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,615.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,423.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,019.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,205.20
|
| Rate for Payer: Multiplan Commercial |
$4,519.50
|
| Rate for Payer: Networks By Design Commercial |
$3,916.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,122.10
|
|
|
HC SUTR/STPL RMVL REQUIRING ANES
|
Facility
OP
|
$6,026.00
|
|
|
Service Code
|
CPT 15851
|
| Hospital Charge Code |
907201033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,205.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,615.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$2,711.70
|
| Rate for Payer: Cash Price |
$2,711.70
|
| Rate for Payer: Cash Price |
$2,711.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,820.80
|
| Rate for Payer: Cigna of CA PPO |
$4,459.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$5,122.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,615.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,423.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,519.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,019.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,205.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$4,519.50
|
| Rate for Payer: Networks By Design Commercial |
$3,916.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,122.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,615.60
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,615.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC SUTR VICRYL 5-0 PS-2 18" UNDYE
|
Facility
OP
|
$25.50
|
|
| Hospital Charge Code |
901698138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$14.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$14.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.07
|
| Rate for Payer: BCBS Transplant Transplant |
$15.30
|
| Rate for Payer: Blue Shield of California Commercial |
$16.04
|
| Rate for Payer: Blue Shield of California EPN |
$12.47
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$16.32
|
| Rate for Payer: Cigna of CA PPO |
$18.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$19.12
|
| Rate for Payer: IEHP medi-cal |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.58
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$15.30
|
| Rate for Payer: Riverside University Health MISP |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other HMO |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$12.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.68
|
| Rate for Payer: Vantage Medical Group Senior |
$21.68
|
|
|
HC SUTR VICRYL 5-0 PS-2 18" UNDYE
|
Facility
IP
|
$25.50
|
|
| Hospital Charge Code |
901698138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.58
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
|
|
HC SUTURE BONE WAX 2.5G
|
Facility
OP
|
$35.51
|
|
| Hospital Charge Code |
901604011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$31.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$21.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.18
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.98
|
| Rate for Payer: BCBS Transplant Transplant |
$21.31
|
| Rate for Payer: Blue Shield of California Commercial |
$22.34
|
| Rate for Payer: Blue Shield of California EPN |
$17.36
|
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Central Health Plan Commercial |
$28.41
|
| Rate for Payer: Cigna of CA HMO |
$22.73
|
| Rate for Payer: Cigna of CA PPO |
$26.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.18
|
| Rate for Payer: Global Benefits Group Commercial |
$21.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.96
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.63
|
| Rate for Payer: IEHP medi-cal |
$12.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$26.63
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.31
|
| Rate for Payer: Riverside University Health MISP |
$14.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.76
|
| Rate for Payer: United Healthcare All Other HMO |
$17.76
|
| Rate for Payer: United Healthcare HMO Rider |
$17.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.18
|
| Rate for Payer: Vantage Medical Group Senior |
$30.18
|
|
|
HC SUTURE BONE WAX 2.5G
|
Facility
IP
|
$35.51
|
|
| Hospital Charge Code |
901604011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.10 |
| Max. Negotiated Rate |
$31.96 |
| Rate for Payer: Cash Price |
$15.98
|
| Rate for Payer: Central Health Plan Commercial |
$28.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.20
|
| Rate for Payer: Galaxy Health WC |
$30.18
|
| Rate for Payer: Global Benefits Group Commercial |
$21.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.10
|
| Rate for Payer: Multiplan Commercial |
$26.63
|
| Rate for Payer: Networks By Design Commercial |
$23.08
|
| Rate for Payer: Prime Health Services Commercial |
$30.18
|
|
|
HC SUTURE CHROMIC 0 CT-1 105252
|
Facility
IP
|
$20.58
|
|
| Hospital Charge Code |
901694630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC SUTURE CHROMIC 0 CT-1 105252
|
Facility
OP
|
$20.58
|
|
| Hospital Charge Code |
901694630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.16
|
| Rate for Payer: BCBS Transplant Transplant |
$12.35
|
| Rate for Payer: Blue Shield of California Commercial |
$12.94
|
| Rate for Payer: Blue Shield of California EPN |
$10.06
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15.44
|
| Rate for Payer: IEHP medi-cal |
$7.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: Riverside University Health MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
