|
HC CYTOPATH,SCREENING OTHER SOURC
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800003
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Cash Price |
$182.70
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$77.56 |
| Rate for Payer: Adventist Health Medi-Cal |
$17.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$77.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.83
|
| Rate for Payer: Blue Distinction Transplant |
$24.00
|
| Rate for Payer: Blue Shield of California Commercial |
$24.72
|
| Rate for Payer: Blue Shield of California EPN |
$19.44
|
| Rate for Payer: Caremore Medicare Advantage |
$17.31
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Central Health Plan Commercial |
$32.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.96
|
| Rate for Payer: Dignity Health Media |
$17.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$17.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.31
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$28.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.31
|
| Rate for Payer: InnovAge PACE Commercial |
$25.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.20
|
| Rate for Payer: Multiplan Commercial |
$30.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Prime Health Services Medicare |
$18.35
|
| Rate for Payer: Riverside University Health System MISP |
$19.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.04
|
| Rate for Payer: Vantage Medical Group Senior |
$17.31
|
|
|
HC CYTOPATH SCRNG-TECH
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT P3000
|
| Hospital Charge Code |
903800013
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$88.20 |
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Central Health Plan Commercial |
$78.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.20
|
| Rate for Payer: Galaxy Health WC |
$83.30
|
| Rate for Payer: Global Benefits Group Commercial |
$58.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$65.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$73.50
|
| Rate for Payer: Networks By Design Commercial |
$63.70
|
| Rate for Payer: Prime Health Services Commercial |
$83.30
|
|
|
HC CYTOPATH SMEARS ANY SOURCE PG
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$64.80 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.80
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
|
|
HC CYTOPATH SMEARS ANY SOURCE PG
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
903800215
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$14.40 |
| Max. Negotiated Rate |
$171.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.00
|
| Rate for Payer: Blue Distinction Transplant |
$43.20
|
| Rate for Payer: Blue Shield of California Commercial |
$44.50
|
| Rate for Payer: Blue Shield of California EPN |
$34.99
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Central Health Plan Commercial |
$57.60
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Media |
$37.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: InnovAge PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$54.00
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Riverside University Health System MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC CYTOPATH SMEARS PG
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$77.40 |
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.40
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
|
|
HC CYTOPATH SMEARS PG
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 88108
|
| Hospital Charge Code |
903800291
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.20 |
| Max. Negotiated Rate |
$270.28 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.49
|
| Rate for Payer: Blue Distinction Transplant |
$51.60
|
| Rate for Payer: Blue Shield of California Commercial |
$53.15
|
| Rate for Payer: Blue Shield of California EPN |
$41.80
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Central Health Plan Commercial |
$68.80
|
| Rate for Payer: Cigna of CA HMO |
$55.04
|
| Rate for Payer: Cigna of CA PPO |
$63.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$73.10
|
| Rate for Payer: Global Benefits Group Commercial |
$51.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: InnovAge PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$64.50
|
| Rate for Payer: Networks By Design Commercial |
$55.90
|
| Rate for Payer: Prime Health Services Commercial |
$73.10
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Riverside University Health System MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC CYTOPATH THINPREP PAP
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$16.41 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$20.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$102.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.45
|
| Rate for Payer: Blue Distinction Transplant |
$103.20
|
| Rate for Payer: Blue Shield of California Commercial |
$106.30
|
| Rate for Payer: Blue Shield of California EPN |
$83.59
|
| Rate for Payer: Caremore Medicare Advantage |
$20.26
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Media |
$20.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.35
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$20.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.26
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$129.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$33.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.26
|
| Rate for Payer: InnovAge PACE Commercial |
$30.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.15
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Medicare |
$21.48
|
| Rate for Payer: Riverside University Health System MISP |
$22.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.41
|
| Rate for Payer: United Healthcare All Other HMO |
$16.41
|
| Rate for Payer: United Healthcare HMO Rider |
$16.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
HC CYTOPATH THINPREP PAP
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800245
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC CYTOPATH THINPREP PAP RESCRN
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 88143
|
| Hospital Charge Code |
903800246
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$18.67 |
| Max. Negotiated Rate |
$137.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$23.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.40
|
| Rate for Payer: Blue Distinction Transplant |
$86.40
|
| Rate for Payer: Blue Shield of California Commercial |
$88.99
|
| Rate for Payer: Blue Shield of California EPN |
$69.98
|
| Rate for Payer: Caremore Medicare Advantage |
$23.04
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.56
|
| Rate for Payer: Dignity Health Media |
$23.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$23.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.04
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$37.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$38.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23.04
|
| Rate for Payer: InnovAge PACE Commercial |
$34.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.87
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Medicare |
$24.42
|
| Rate for Payer: Riverside University Health System MISP |
$25.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.67
|
| Rate for Payer: United Healthcare All Other HMO |
$18.67
|
| Rate for Payer: United Healthcare HMO Rider |
$18.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.34
|
| Rate for Payer: Vantage Medical Group Senior |
$23.04
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.80
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
IP
|
$835.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$167.00 |
| Max. Negotiated Rate |
$751.50 |
| Rate for Payer: Cash Price |
$375.75
|
| Rate for Payer: Central Health Plan Commercial |
$668.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$334.00
|
| Rate for Payer: Galaxy Health WC |
$709.75
|
| Rate for Payer: Global Benefits Group Commercial |
$501.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$751.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$318.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$626.25
|
| Rate for Payer: Networks By Design Commercial |
$542.75
|
| Rate for Payer: Prime Health Services Commercial |
$709.75
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$835.00
|
|
|
Service Code
|
CPT 70170
|
| Hospital Charge Code |
909001115
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$1,292.24 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,292.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$239.20
|
| Rate for Payer: Blue Distinction Transplant |
$501.00
|
| Rate for Payer: Blue Shield of California Commercial |
$516.03
|
| Rate for Payer: Blue Shield of California EPN |
$405.81
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$375.75
|
| Rate for Payer: Cash Price |
$375.75
|
| Rate for Payer: Central Health Plan Commercial |
$668.00
|
| Rate for Payer: Cigna of CA HMO |
$534.40
|
| Rate for Payer: Cigna of CA PPO |
$617.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$709.75
|
| Rate for Payer: Global Benefits Group Commercial |
$501.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$751.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$626.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$167.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$626.25
|
| Rate for Payer: Networks By Design Commercial |
$542.75
|
| Rate for Payer: Prime Health Services Commercial |
$709.75
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$501.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$501.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DACRYOCYSTOGRAM
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 68850
|
| Hospital Charge Code |
909000209
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$74.80 |
| 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 |
$317.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.70
|
| 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 |
$224.40
|
| 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 |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.90
|
| Rate for Payer: Dignity Health Media |
$317.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$280.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$461.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.80
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Riverside University Health System MISP |
$149.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.90
|
| Rate for Payer: Vantage Medical Group Senior |
$317.90
|
|
|
HC DAY PROGRAM FULL DAY
|
Facility
|
IP
|
$1,131.00
|
|
| Hospital Charge Code |
905106001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$226.20 |
| Max. Negotiated Rate |
$1,017.90 |
| Rate for Payer: Cash Price |
$508.95
|
| Rate for Payer: Central Health Plan Commercial |
$904.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.40
|
| Rate for Payer: Galaxy Health WC |
$961.35
|
| Rate for Payer: Global Benefits Group Commercial |
$678.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,017.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$754.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$848.25
|
| Rate for Payer: Networks By Design Commercial |
$735.15
|
| Rate for Payer: Prime Health Services Commercial |
$961.35
|
|
|
HC DAY PROGRAM FULL DAY
|
Facility
|
OP
|
$1,131.00
|
|
| Hospital Charge Code |
905106001
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$1,017.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$686.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$961.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$622.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$622.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$678.60
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$508.95
|
| Rate for Payer: Cash Price |
$508.95
|
| Rate for Payer: Cash Price |
$508.95
|
| Rate for Payer: Central Health Plan Commercial |
$904.80
|
| Rate for Payer: Cigna of CA HMO |
$723.84
|
| Rate for Payer: Cigna of CA PPO |
$836.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$961.35
|
| Rate for Payer: Dignity Health Media |
$961.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$961.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$452.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$452.40
|
| Rate for Payer: Galaxy Health WC |
$961.35
|
| Rate for Payer: Global Benefits Group Commercial |
$678.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,017.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$848.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$395.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$754.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$430.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$463.71
|
| Rate for Payer: Multiplan Commercial |
$848.25
|
| Rate for Payer: Networks By Design Commercial |
$735.15
|
| Rate for Payer: Prime Health Services Commercial |
$961.35
|
| Rate for Payer: Riverside University Health System MISP |
$452.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$678.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$678.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$961.35
|
| Rate for Payer: Vantage Medical Group Senior |
$961.35
|
|
|
HC DAY PROGRAM HALF DAY
|
Facility
|
IP
|
$774.00
|
|
| Hospital Charge Code |
905106000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$154.80 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.80
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
|
|
HC DAY PROGRAM HALF DAY
|
Facility
|
OP
|
$774.00
|
|
| Hospital Charge Code |
905106000
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$696.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$470.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$657.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$425.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$425.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$464.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Central Health Plan Commercial |
$619.20
|
| Rate for Payer: Cigna of CA HMO |
$495.36
|
| Rate for Payer: Cigna of CA PPO |
$572.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$657.90
|
| Rate for Payer: Dignity Health Media |
$657.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$657.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$309.60
|
| Rate for Payer: Galaxy Health WC |
$657.90
|
| Rate for Payer: Global Benefits Group Commercial |
$464.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$696.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$580.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$270.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$516.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$294.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.34
|
| Rate for Payer: Multiplan Commercial |
$580.50
|
| Rate for Payer: Networks By Design Commercial |
$503.10
|
| Rate for Payer: Prime Health Services Commercial |
$657.90
|
| Rate for Payer: Riverside University Health System MISP |
$309.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$464.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$464.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$657.90
|
| Rate for Payer: Vantage Medical Group Senior |
$657.90
|
|
|
HC D DIMER
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$90.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$10.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$90.27
|
| Rate for Payer: Blue Distinction Transplant |
$18.60
|
| Rate for Payer: Blue Shield of California Commercial |
$19.16
|
| Rate for Payer: Blue Shield of California EPN |
$15.07
|
| Rate for Payer: Caremore Medicare Advantage |
$10.18
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.27
|
| Rate for Payer: Dignity Health Media |
$10.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$10.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.18
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$16.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.18
|
| Rate for Payer: InnovAge PACE Commercial |
$15.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Prime Health Services Medicare |
$10.79
|
| Rate for Payer: Riverside University Health System MISP |
$11.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.24
|
| Rate for Payer: United Healthcare All Other HMO |
$8.24
|
| Rate for Payer: United Healthcare HMO Rider |
$8.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.20
|
| Rate for Payer: Vantage Medical Group Senior |
$10.18
|
|
|
HC D DIMER
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
900910024
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$51.60 |
| Max. Negotiated Rate |
$232.20 |
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Central Health Plan Commercial |
$206.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.20
|
| Rate for Payer: Galaxy Health WC |
$219.30
|
| Rate for Payer: Global Benefits Group Commercial |
$154.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$232.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$193.50
|
| Rate for Payer: Networks By Design Commercial |
$167.70
|
| Rate for Payer: Prime Health Services Commercial |
$219.30
|
|
|
HC DEB INFCTD SKIN LT 10% BDY SURF
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
902890275
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Central Health Plan Commercial |
$709.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.80
|
| Rate for Payer: Galaxy Health WC |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$798.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$591.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.40
|
| Rate for Payer: Multiplan Commercial |
$665.25
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
|
|
HC DEB INFCTD SKIN LT 10% BDY SURF
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT 11000
|
| Hospital Charge Code |
902890275
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$37.49 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$784.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$863.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$784.71
|
| 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 |
$532.20
|
| Rate for Payer: Blue Shield of California Commercial |
$557.92
|
| Rate for Payer: Blue Shield of California EPN |
$433.74
|
| Rate for Payer: Caremore Medicare Advantage |
$784.71
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Central Health Plan Commercial |
$709.60
|
| Rate for Payer: Cigna of CA HMO |
$567.68
|
| Rate for Payer: Cigna of CA PPO |
$656.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,177.06
|
| Rate for Payer: Dignity Health Media |
$784.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$863.18
|
| 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 |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$798.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$665.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,286.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,294.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$784.71
|
| Rate for Payer: InnovAge PACE Commercial |
$1,177.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$591.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$784.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.40
|
| 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 |
$665.25
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
| Rate for Payer: Prime Health Services Medicare |
$831.79
|
| Rate for Payer: Riverside University Health System MISP |
$863.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$532.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$443.50
|
| Rate for Payer: United Healthcare All Other HMO |
$443.50
|
| Rate for Payer: United Healthcare HMO Rider |
$443.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$443.50
|
| 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 DEB MUSCLE AND OR FASCIA EACH ADDL 20 SQ CM
|
Facility
|
OP
|
$828.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
900101492
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$59.41 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$703.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$455.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$455.40
|
| 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 |
$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: Dignity Health Media |
$703.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$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) Other |
$621.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$289.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$552.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.41
|
| 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: Riverside University Health System MISP |
$331.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| 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 DEB MUSCLE AND OR FASCIA EACH ADDL 20 SQ CM
|
Facility
|
IP
|
$828.00
|
|
|
Service Code
|
CPT 11046
|
| Hospital Charge Code |
900101492
|
|
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: Kaiser Permanente of CA Medi-Cal |
$315.47
|
| 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
|
|
