|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
905355850
|
|
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: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| 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
|
| Rate for Payer: United Healthcare All Other Commercial |
$154.82
|
| Rate for Payer: United Healthcare All Other HMO |
$151.21
|
| Rate for Payer: United Healthcare HMO Rider |
$147.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.30
|
|
|
HC ADHESIVE DERMABOND HV PRCSN
|
Facility
|
IP
|
$169.82
|
|
| Hospital Charge Code |
901691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$152.84 |
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Central Health Plan Commercial |
$135.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.93
|
| Rate for Payer: Galaxy Health WC |
$144.35
|
| Rate for Payer: Global Benefits Group Commercial |
$101.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.96
|
| Rate for Payer: Multiplan Commercial |
$127.36
|
| Rate for Payer: Networks By Design Commercial |
$110.38
|
| Rate for Payer: Prime Health Services Commercial |
$144.35
|
|
|
HC ADHESIVE DERMABOND HV PRCSN
|
Facility
|
OP
|
$169.82
|
|
| Hospital Charge Code |
901691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$152.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$103.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$93.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.33
|
| Rate for Payer: Blue Distinction Transplant |
$101.89
|
| Rate for Payer: Blue Shield of California Commercial |
$106.82
|
| Rate for Payer: Blue Shield of California EPN |
$83.04
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Central Health Plan Commercial |
$135.86
|
| Rate for Payer: Cigna of CA HMO |
$108.68
|
| Rate for Payer: Cigna of CA PPO |
$125.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.35
|
| Rate for Payer: Dignity Health Media |
$144.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.93
|
| Rate for Payer: Galaxy Health WC |
$144.35
|
| Rate for Payer: Global Benefits Group Commercial |
$101.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$127.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.96
|
| Rate for Payer: Multiplan Commercial |
$127.36
|
| Rate for Payer: Networks By Design Commercial |
$110.38
|
| Rate for Payer: Prime Health Services Commercial |
$144.35
|
| Rate for Payer: Riverside University Health System MISP |
$67.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.91
|
| Rate for Payer: United Healthcare All Other HMO |
$84.91
|
| Rate for Payer: United Healthcare HMO Rider |
$84.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$144.35
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
IP
|
$143.49
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$129.14 |
| Rate for Payer: Cash Price |
$64.57
|
| Rate for Payer: Central Health Plan Commercial |
$114.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.40
|
| Rate for Payer: Galaxy Health WC |
$121.97
|
| Rate for Payer: Global Benefits Group Commercial |
$86.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$107.62
|
| Rate for Payer: Networks By Design Commercial |
$93.27
|
| Rate for Payer: Prime Health Services Commercial |
$121.97
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
OP
|
$143.49
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.70 |
| Max. Negotiated Rate |
$129.14 |
| Rate for Payer: Aetna of CA HMO/PPO |
$87.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$69.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.77
|
| Rate for Payer: Blue Distinction Transplant |
$86.09
|
| Rate for Payer: Blue Shield of California Commercial |
$90.26
|
| Rate for Payer: Blue Shield of California EPN |
$70.17
|
| Rate for Payer: Cash Price |
$64.57
|
| Rate for Payer: Central Health Plan Commercial |
$114.79
|
| Rate for Payer: Cigna of CA HMO |
$91.83
|
| Rate for Payer: Cigna of CA PPO |
$106.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.97
|
| Rate for Payer: Dignity Health Media |
$121.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$57.40
|
| Rate for Payer: Galaxy Health WC |
$121.97
|
| Rate for Payer: Global Benefits Group Commercial |
$86.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.14
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$107.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$50.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$107.62
|
| Rate for Payer: Networks By Design Commercial |
$93.27
|
| Rate for Payer: Prime Health Services Commercial |
$121.97
|
| Rate for Payer: Riverside University Health System MISP |
$57.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.74
|
| Rate for Payer: United Healthcare All Other HMO |
$71.74
|
| Rate for Payer: United Healthcare HMO Rider |
$71.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.97
|
| Rate for Payer: Vantage Medical Group Senior |
$121.97
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
IP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Central Health Plan Commercial |
$52.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.07
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
OP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$58.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.61
|
| Rate for Payer: Blue Distinction Transplant |
$39.21
|
| Rate for Payer: Blue Shield of California Commercial |
$41.11
|
| Rate for Payer: Blue Shield of California EPN |
$31.96
|
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Central Health Plan Commercial |
$52.28
|
| Rate for Payer: Cigna of CA HMO |
$41.82
|
| Rate for Payer: Cigna of CA PPO |
$48.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.55
|
| Rate for Payer: Dignity Health Media |
$55.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$49.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.07
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
| Rate for Payer: Riverside University Health System MISP |
$26.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.68
|
| Rate for Payer: United Healthcare All Other HMO |
$32.68
|
| Rate for Payer: United Healthcare HMO Rider |
$32.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Vantage Medical Group Senior |
$55.55
|
|
|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
IP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$104.31 |
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Central Health Plan Commercial |
$92.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$86.92
|
| Rate for Payer: Networks By Design Commercial |
$75.34
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
|
|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
OP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$104.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$70.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.47
|
| Rate for Payer: Blue Distinction Transplant |
$69.54
|
| Rate for Payer: Blue Shield of California Commercial |
$72.90
|
| Rate for Payer: Blue Shield of California EPN |
$56.68
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Central Health Plan Commercial |
$92.72
|
| Rate for Payer: Cigna of CA HMO |
$74.18
|
| Rate for Payer: Cigna of CA PPO |
$85.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.52
|
| Rate for Payer: Dignity Health Media |
$98.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.31
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$86.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.18
|
| Rate for Payer: Multiplan Commercial |
$86.92
|
| Rate for Payer: Networks By Design Commercial |
$75.34
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
| Rate for Payer: Riverside University Health System MISP |
$46.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.95
|
| Rate for Payer: United Healthcare All Other HMO |
$57.95
|
| Rate for Payer: United Healthcare HMO Rider |
$57.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.52
|
| Rate for Payer: Vantage Medical Group Senior |
$98.52
|
|
|
HC ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
OP
|
$11,707.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.04 |
| Max. Negotiated Rate |
$10,536.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| 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: Blue Distinction Transplant |
$7,024.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$5,268.15
|
| Rate for Payer: Cash Price |
$5,268.15
|
| Rate for Payer: Cash Price |
$5,268.15
|
| Rate for Payer: Cash Price |
$5,268.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,365.60
|
| Rate for Payer: Cigna of CA PPO |
$8,663.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$9,950.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,024.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,536.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,780.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (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 |
$7,808.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.40
|
| 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 |
$8,780.25
|
| Rate for Payer: Networks By Design Commercial |
$7,609.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,950.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,024.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,853.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,853.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,853.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,853.50
|
| 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 ADJACNT TISS TRNSF LT 10 SQ CM
|
Facility
|
IP
|
$11,707.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
900501289
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,341.40 |
| Max. Negotiated Rate |
$10,536.30 |
| Rate for Payer: Cash Price |
$5,268.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,365.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,682.80
|
| Rate for Payer: Galaxy Health WC |
$9,950.95
|
| Rate for Payer: Global Benefits Group Commercial |
$7,024.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,536.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,808.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,460.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,341.40
|
| Rate for Payer: Multiplan Commercial |
$8,780.25
|
| Rate for Payer: Networks By Design Commercial |
$7,609.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,950.95
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$4,179.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$835.80 |
| Max. Negotiated Rate |
$3,761.10 |
| Rate for Payer: Cash Price |
$1,880.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,343.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,671.60
|
| Rate for Payer: Galaxy Health WC |
$3,552.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,507.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,761.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,787.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,592.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.80
|
| Rate for Payer: Multiplan Commercial |
$3,134.25
|
| Rate for Payer: Networks By Design Commercial |
$2,716.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,552.15
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$1,484.10 |
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,484.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.80
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$2,096.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,257.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.80
|
| Rate for Payer: Cigna of CA PPO |
$1,551.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,781.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,886.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,572.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: Networks By Design Commercial |
$1,362.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,781.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,048.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,048.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,048.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,048.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
IP
|
$4,179.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$835.80 |
| Max. Negotiated Rate |
$3,761.10 |
| Rate for Payer: Cash Price |
$1,880.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,343.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,671.60
|
| Rate for Payer: Galaxy Health WC |
$3,552.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,507.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,761.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,787.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,592.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.80
|
| Rate for Payer: Multiplan Commercial |
$3,134.25
|
| Rate for Payer: Networks By Design Commercial |
$2,716.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,552.15
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT S2083
|
| Hospital Charge Code |
909020143
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$329.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$906.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$906.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$989.40
|
| 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 |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,319.20
|
| Rate for Payer: Cigna of CA PPO |
$1,220.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,401.65
|
| Rate for Payer: Dignity Health Media |
$1,401.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,401.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,484.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,236.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$577.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.80
|
| Rate for Payer: Multiplan Commercial |
$1,236.75
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
| Rate for Payer: Riverside University Health System MISP |
$659.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$989.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.50
|
| Rate for Payer: United Healthcare All Other HMO |
$824.50
|
| Rate for Payer: United Healthcare HMO Rider |
$824.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,401.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,401.65
|
|
|
HC ADJ GASTRIC BAND DIAM VIA PORT
|
Facility
|
OP
|
$2,096.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
906743999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$419.20 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,014.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,238.32
|
| Rate for Payer: Blue Distinction Transplant |
$1,257.60
|
| 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 |
$1,132.59
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Cash Price |
$943.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,676.80
|
| Rate for Payer: Cigna of CA PPO |
$1,551.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$1,781.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,886.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,572.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,398.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: Networks By Design Commercial |
$1,362.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,781.60
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| 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 |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
OP
|
$8,642.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$5,185.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$3,888.90
|
| Rate for Payer: Cash Price |
$3,888.90
|
| Rate for Payer: Cash Price |
$3,888.90
|
| Rate for Payer: Cash Price |
$3,888.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,913.60
|
| Rate for Payer: Cigna of CA PPO |
$6,395.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$7,345.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,777.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,481.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (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 |
$5,764.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.40
|
| 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 |
$6,481.50
|
| Rate for Payer: Networks By Design Commercial |
$5,617.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,345.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,185.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,321.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,321.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,321.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,321.00
|
| 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 ADJ TISS TRNSFR 10 SQ CM OR LT
|
Facility
|
IP
|
$8,642.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
900501331
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,728.40 |
| Max. Negotiated Rate |
$7,777.80 |
| Rate for Payer: Cash Price |
$3,888.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,456.80
|
| Rate for Payer: Galaxy Health WC |
$7,345.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,777.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,764.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,292.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,728.40
|
| Rate for Payer: Multiplan Commercial |
$6,481.50
|
| Rate for Payer: Networks By Design Commercial |
$5,617.30
|
| Rate for Payer: Prime Health Services Commercial |
$7,345.70
|
|
|
HC ADJUSTABLE MOBILE ARM SUPPORT
|
Facility
|
IP
|
$1,929.00
|
|
|
Service Code
|
CPT L3964
|
| Hospital Charge Code |
903203964
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$385.80 |
| Max. Negotiated Rate |
$1,736.10 |
| Rate for Payer: Cash Price |
$868.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,543.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$771.60
|
| Rate for Payer: Galaxy Health WC |
$1,639.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,157.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,736.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,286.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.80
|
| Rate for Payer: Multiplan Commercial |
$1,446.75
|
| Rate for Payer: Networks By Design Commercial |
$1,253.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,639.65
|
|
|
HC ADJUSTABLE MOBILE ARM SUPPORT
|
Facility
|
OP
|
$1,929.00
|
|
|
Service Code
|
CPT L3964
|
| Hospital Charge Code |
903203964
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$385.80 |
| Max. Negotiated Rate |
$1,736.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,171.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,639.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,060.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,060.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$934.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,139.65
|
| Rate for Payer: Blue Distinction Transplant |
$1,157.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,213.34
|
| Rate for Payer: Blue Shield of California EPN |
$943.28
|
| Rate for Payer: Cash Price |
$868.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,543.20
|
| Rate for Payer: Cigna of CA HMO |
$1,234.56
|
| Rate for Payer: Cigna of CA PPO |
$1,427.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,639.65
|
| Rate for Payer: Dignity Health Media |
$1,639.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,639.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$771.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$771.60
|
| Rate for Payer: Galaxy Health WC |
$1,639.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,157.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,736.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,446.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$675.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,286.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$734.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.80
|
| Rate for Payer: Multiplan Commercial |
$1,446.75
|
| Rate for Payer: Networks By Design Commercial |
$1,253.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,639.65
|
| Rate for Payer: Riverside University Health System MISP |
$771.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,157.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,157.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$964.50
|
| Rate for Payer: United Healthcare All Other HMO |
$964.50
|
| Rate for Payer: United Healthcare HMO Rider |
$964.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$964.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,639.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,639.65
|
|
|
HC ADM FR D LOW A/D SAME DT-HR
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
|
|
HC ADM FR D LOW A/D SAME DT-HR
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100007
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: Blue Distinction Transplant |
$141.60
|
| Rate for Payer: Blue Shield of California Commercial |
$148.44
|
| Rate for Payer: Blue Shield of California EPN |
$115.40
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: Cigna of CA PPO |
$174.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.60
|
| Rate for Payer: Dignity Health Media |
$200.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$177.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
| Rate for Payer: Riverside University Health System MISP |
$94.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.60
|
| Rate for Payer: Vantage Medical Group Senior |
$200.60
|
|
|
HC ADM FR H-COMP A/D SAME/ HR
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$9,113.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$142.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: Blue Distinction Transplant |
$155.40
|
| Rate for Payer: Blue Shield of California Commercial |
$162.91
|
| Rate for Payer: Blue Shield of California EPN |
$126.65
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Media |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$194.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$90.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Riverside University Health System MISP |
$103.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,112.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,007.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC ADM FR H-COMP A/D SAME/ HR
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT G0378
|
| Hospital Charge Code |
902100009
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
|
