|
HC DELIVERY OF PLACENTA
|
Facility
|
OP
|
$8,674.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$7,806.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$457.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| 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 |
$5,204.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,455.95
|
| Rate for Payer: Blue Shield of California EPN |
$4,241.59
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,939.20
|
| Rate for Payer: Cigna of CA HMO |
$5,551.36
|
| Rate for Payer: Cigna of CA PPO |
$6,418.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$7,372.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,204.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,806.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,505.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,785.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,505.50
|
| Rate for Payer: Networks By Design Commercial |
$5,638.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,372.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,204.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,204.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
IP
|
$8,674.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,734.80 |
| Max. Negotiated Rate |
$7,806.60 |
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,939.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,469.60
|
| Rate for Payer: Galaxy Health WC |
$7,372.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,204.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,806.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,785.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.80
|
| Rate for Payer: Multiplan Commercial |
$6,505.50
|
| Rate for Payer: Networks By Design Commercial |
$5,638.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,372.90
|
|
|
HC DELIVERY OF PLACENTA
|
Facility
|
OP
|
$8,674.00
|
|
|
Service Code
|
CPT 59414
|
| Hospital Charge Code |
902400375
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.93 |
| Max. Negotiated Rate |
$7,806.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| 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 |
$5,204.40
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Cash Price |
$3,903.30
|
| Rate for Payer: Central Health Plan Commercial |
$6,939.20
|
| Rate for Payer: Cigna of CA PPO |
$6,418.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$7,372.90
|
| Rate for Payer: Global Benefits Group Commercial |
$5,204.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,806.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,505.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,785.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,734.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$6,505.50
|
| Rate for Payer: Networks By Design Commercial |
$5,638.10
|
| Rate for Payer: Prime Health Services Commercial |
$7,372.90
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,204.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,337.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,337.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,337.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,337.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$16.34 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$134.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$232.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: Cigna of CA HMO |
$248.32
|
| Rate for Payer: Cigna of CA PPO |
$287.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: Dignity Health Media |
$266.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$293.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$291.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$439.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$266.49
|
| Rate for Payer: InnovAge PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Riverside University Health System MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$232.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC DEMO/EVAL PT UTILIZATN INHALER
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 94664
|
| Hospital Charge Code |
900800112
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.60 |
| Max. Negotiated Rate |
$349.20 |
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Central Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.20
|
| Rate for Payer: Galaxy Health WC |
$329.80
|
| Rate for Payer: Global Benefits Group Commercial |
$232.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$349.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.60
|
| Rate for Payer: Multiplan Commercial |
$291.00
|
| Rate for Payer: Networks By Design Commercial |
$252.20
|
| Rate for Payer: Prime Health Services Commercial |
$329.80
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
905353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Blue Shield of California EPN |
$95.05
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.21
|
| Rate for Payer: United Healthcare All Other HMO |
$65.65
|
| Rate for Payer: United Healthcare HMO Rider |
$64.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.74
|
|
|
HC DENNIS BROWNE CLAMPED
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT L3150
|
| Hospital Charge Code |
905353150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.16
|
| Rate for Payer: Blue Distinction Transplant |
$106.80
|
| Rate for Payer: Blue Shield of California Commercial |
$133.50
|
| Rate for Payer: Blue Shield of California EPN |
$96.83
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$124.60
|
| Rate for Payer: Cigna of CA PPO |
$124.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Media |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$133.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.98
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$89.00
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Riverside University Health System MISP |
$71.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.00
|
| Rate for Payer: United Healthcare All Other HMO |
$89.00
|
| Rate for Payer: United Healthcare HMO Rider |
$89.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
IP
|
$662.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$132.40 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Central Health Plan Commercial |
$529.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$595.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.40
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
| Rate for Payer: Networks By Design Commercial |
$430.30
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
|
|
HC DENTAL IMPLANT/NOBLEGUIDE
|
Facility
|
OP
|
$662.00
|
|
| Hospital Charge Code |
909201006
|
|
Hospital Revenue Code
|
352
|
| Min. Negotiated Rate |
$132.40 |
| Max. Negotiated Rate |
$595.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$402.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$364.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$364.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$320.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.11
|
| Rate for Payer: Blue Distinction Transplant |
$397.20
|
| Rate for Payer: Blue Shield of California Commercial |
$409.12
|
| Rate for Payer: Blue Shield of California EPN |
$321.73
|
| Rate for Payer: Cash Price |
$297.90
|
| Rate for Payer: Central Health Plan Commercial |
$529.60
|
| Rate for Payer: Cigna of CA HMO |
$423.68
|
| Rate for Payer: Cigna of CA PPO |
$489.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.70
|
| Rate for Payer: Dignity Health Media |
$562.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$562.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$264.80
|
| Rate for Payer: Galaxy Health WC |
$562.70
|
| Rate for Payer: Global Benefits Group Commercial |
$397.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$595.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$496.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$231.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$441.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$252.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.40
|
| Rate for Payer: Multiplan Commercial |
$496.50
|
| Rate for Payer: Networks By Design Commercial |
$430.30
|
| Rate for Payer: Prime Health Services Commercial |
$562.70
|
| Rate for Payer: Riverside University Health System MISP |
$264.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$397.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$397.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$331.00
|
| Rate for Payer: United Healthcare All Other HMO |
$331.00
|
| Rate for Payer: United Healthcare HMO Rider |
$331.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$331.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$562.70
|
| Rate for Payer: Vantage Medical Group Senior |
$562.70
|
|
|
HC DERMABOND
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$43.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.67
|
| Rate for Payer: Blue Distinction Transplant |
$47.40
|
| Rate for Payer: Blue Shield of California Commercial |
$49.69
|
| Rate for Payer: Blue Shield of California EPN |
$38.63
|
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: Cigna of CA HMO |
$50.56
|
| Rate for Payer: Cigna of CA PPO |
$58.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67.15
|
| Rate for Payer: Dignity Health Media |
$67.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$67.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$59.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
| Rate for Payer: Riverside University Health System MISP |
$31.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$39.50
|
| Rate for Payer: United Healthcare All Other HMO |
$39.50
|
| Rate for Payer: United Healthcare HMO Rider |
$39.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67.15
|
| Rate for Payer: Vantage Medical Group Senior |
$67.15
|
|
|
HC DERMABOND
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
909081731
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$71.10 |
| Rate for Payer: Cash Price |
$35.55
|
| Rate for Payer: Central Health Plan Commercial |
$63.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31.60
|
| Rate for Payer: Galaxy Health WC |
$67.15
|
| Rate for Payer: Global Benefits Group Commercial |
$47.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$71.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.80
|
| Rate for Payer: Multiplan Commercial |
$59.25
|
| Rate for Payer: Networks By Design Commercial |
$51.35
|
| Rate for Payer: Prime Health Services Commercial |
$67.15
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC DERMATOPHAGOIDES MICROCERAS IGE
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913636
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: Blue Distinction Transplant |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$39.55
|
| Rate for Payer: Blue Shield of California EPN |
$31.10
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Media |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: InnovAge PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
OP
|
$9,203.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$338.50 |
| Max. Negotiated Rate |
$8,282.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,380.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,198.96
|
| Rate for Payer: Blue Distinction Transplant |
$5,521.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,687.45
|
| Rate for Payer: Blue Shield of California EPN |
$4,472.66
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,362.40
|
| Rate for Payer: Cigna of CA HMO |
$5,889.92
|
| Rate for Payer: Cigna of CA PPO |
$6,810.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$7,822.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,521.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,282.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,902.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,138.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,840.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,902.25
|
| Rate for Payer: Networks By Design Commercial |
$5,981.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,822.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,521.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,521.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
OP
|
$9,203.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906820023
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$338.50 |
| Max. Negotiated Rate |
$8,282.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,380.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,982.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,622.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,198.96
|
| Rate for Payer: Blue Distinction Transplant |
$5,521.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,687.45
|
| Rate for Payer: Blue Shield of California EPN |
$4,472.66
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,362.40
|
| Rate for Payer: Cigna of CA HMO |
$5,889.92
|
| Rate for Payer: Cigna of CA PPO |
$6,810.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Dignity Health Media |
$3,982.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,380.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,376.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,982.55
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,982.55
|
| Rate for Payer: Galaxy Health WC |
$7,822.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,521.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,282.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,902.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,531.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,571.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,982.55
|
| Rate for Payer: InnovAge PACE Commercial |
$5,973.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,138.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$338.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,840.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,336.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,336.62
|
| Rate for Payer: Multiplan Commercial |
$6,902.25
|
| Rate for Payer: Networks By Design Commercial |
$5,981.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,822.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,221.50
|
| Rate for Payer: Riverside University Health System MISP |
$4,380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,521.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,521.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,973.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,380.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,982.55
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
IP
|
$9,203.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906820023
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,840.60 |
| Max. Negotiated Rate |
$8,282.70 |
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,362.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,681.20
|
| Rate for Payer: Galaxy Health WC |
$7,822.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,521.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,282.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,138.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,840.60
|
| Rate for Payer: Multiplan Commercial |
$6,902.25
|
| Rate for Payer: Networks By Design Commercial |
$5,981.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,822.55
|
|
|
HC DESCENDING THORACIC AORTOGRAM
|
Facility
|
IP
|
$9,203.00
|
|
|
Service Code
|
CPT 75600
|
| Hospital Charge Code |
906811497
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$1,840.60 |
| Max. Negotiated Rate |
$8,282.70 |
| Rate for Payer: Cash Price |
$4,141.35
|
| Rate for Payer: Central Health Plan Commercial |
$7,362.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,681.20
|
| Rate for Payer: Galaxy Health WC |
$7,822.55
|
| Rate for Payer: Global Benefits Group Commercial |
$5,521.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,282.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,138.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,506.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,840.60
|
| Rate for Payer: Multiplan Commercial |
$6,902.25
|
| Rate for Payer: Networks By Design Commercial |
$5,981.95
|
| Rate for Payer: Prime Health Services Commercial |
$7,822.55
|
|
|
HC DESIGN MIC DEVICE FOR IMRT
|
Facility
|
IP
|
$2,074.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
909100215
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$414.80 |
| Max. Negotiated Rate |
$1,866.60 |
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,659.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$829.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$829.60
|
| Rate for Payer: Galaxy Health WC |
$1,762.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,244.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,866.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,383.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$790.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.80
|
| Rate for Payer: Multiplan Commercial |
$1,555.50
|
| Rate for Payer: Networks By Design Commercial |
$1,348.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,762.90
|
|
|
HC DESIGN MIC DEVICE FOR IMRT
|
Facility
|
OP
|
$2,074.00
|
|
|
Service Code
|
CPT 77338
|
| Hospital Charge Code |
909100215
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$414.80 |
| Max. Negotiated Rate |
$2,263.31 |
| Rate for Payer: Adventist Health Medi-Cal |
$461.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,467.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,855.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,263.31
|
| Rate for Payer: Blue Distinction Transplant |
$1,244.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,281.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,007.96
|
| Rate for Payer: Caremore Medicare Advantage |
$461.66
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Cash Price |
$933.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,659.20
|
| Rate for Payer: Cigna of CA HMO |
$1,327.36
|
| Rate for Payer: Cigna of CA PPO |
$1,534.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: Dignity Health Media |
$461.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$1,762.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,244.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,866.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,555.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$757.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$761.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.66
|
| Rate for Payer: InnovAge PACE Commercial |
$692.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,383.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$1,555.50
|
| Rate for Payer: Networks By Design Commercial |
$1,348.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,762.90
|
| Rate for Payer: Prime Health Services Medicare |
$489.36
|
| Rate for Payer: Riverside University Health System MISP |
$507.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,244.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.00 |
| 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 |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| 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 |
$186.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Cigna of CA PPO |
$229.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$232.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$155.00
|
| Rate for Payer: United Healthcare HMO Rider |
$155.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$279.00 |
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.00
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
|
|
HC DEST BENIGN/PREMAL 1ST LESION
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
CPT 17000
|
| Hospital Charge Code |
900501417
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$62.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| 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 |
$186.00
|
| Rate for Payer: Blue Shield of California Commercial |
$194.99
|
| Rate for Payer: Blue Shield of California EPN |
$151.59
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Central Health Plan Commercial |
$248.00
|
| Rate for Payer: Cigna of CA HMO |
$198.40
|
| Rate for Payer: Cigna of CA PPO |
$229.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$263.50
|
| Rate for Payer: Global Benefits Group Commercial |
$186.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$279.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$232.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$206.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$232.50
|
| Rate for Payer: Networks By Design Commercial |
$201.50
|
| Rate for Payer: Prime Health Services Commercial |
$263.50
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$186.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$186.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$155.00
|
| Rate for Payer: United Healthcare All Other HMO |
$155.00
|
| Rate for Payer: United Healthcare HMO Rider |
$155.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$155.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| 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 |
$273.00
|
| Rate for Payer: Blue Shield of California Commercial |
$286.20
|
| Rate for Payer: Blue Shield of California EPN |
$222.50
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$341.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.50
|
| Rate for Payer: United Healthcare All Other HMO |
$227.50
|
| Rate for Payer: United Healthcare HMO Rider |
$227.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
