|
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: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant 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: 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 Transplant Other |
$341.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: 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 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: Redlands Yucaipa Medical Group Commercial/Senior |
$273.00
|
| Rate for Payer: Riverside University Health 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
|
|
|
HC DEST FLAT WARTS UP TO 14 LESIONS
|
Facility
IP
|
$455.00
|
|
|
Service Code
|
CPT 17110
|
| Hospital Charge Code |
900501049
|
|
Hospital Revenue Code
|
450
|
| 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: 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 MALGNANT LESION LT 0.5 CM
|
Facility
IP
|
$729.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$145.80 |
| Max. Negotiated Rate |
$656.10 |
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Central Health Plan Commercial |
$583.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.60
|
| Rate for Payer: Galaxy Health WC |
$619.65
|
| Rate for Payer: Global Benefits Group Commercial |
$437.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.80
|
| Rate for Payer: Multiplan Commercial |
$546.75
|
| Rate for Payer: Networks By Design Commercial |
$473.85
|
| Rate for Payer: Prime Health Services Commercial |
$619.65
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
OP
|
$729.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.80 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$437.40
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Central Health Plan Commercial |
$583.20
|
| Rate for Payer: Cigna of CA PPO |
$539.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$619.65
|
| Rate for Payer: Global Benefits Group Commercial |
$437.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$546.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.80
|
| 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 |
$546.75
|
| Rate for Payer: Networks By Design Commercial |
$473.85
|
| Rate for Payer: Prime Health Services Commercial |
$619.65
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$437.40
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.50
|
| Rate for Payer: United Healthcare All Other HMO |
$364.50
|
| Rate for Payer: United Healthcare HMO Rider |
$364.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.50
|
| 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
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
IP
|
$729.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.80 |
| Max. Negotiated Rate |
$656.10 |
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Central Health Plan Commercial |
$583.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$291.60
|
| Rate for Payer: Galaxy Health WC |
$619.65
|
| Rate for Payer: Global Benefits Group Commercial |
$437.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.80
|
| Rate for Payer: Multiplan Commercial |
$546.75
|
| Rate for Payer: Networks By Design Commercial |
$473.85
|
| Rate for Payer: Prime Health Services Commercial |
$619.65
|
|
|
HC DEST MALGNANT LESION LT 0.5 CM
|
Facility
OP
|
$729.00
|
|
|
Service Code
|
CPT 17280
|
| Hospital Charge Code |
900501361
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$145.80 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$437.40
|
| Rate for Payer: Blue Shield of California Commercial |
$458.54
|
| Rate for Payer: Blue Shield of California EPN |
$356.48
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Cash Price |
$328.05
|
| Rate for Payer: Central Health Plan Commercial |
$583.20
|
| Rate for Payer: Cigna of CA HMO |
$466.56
|
| Rate for Payer: Cigna of CA PPO |
$539.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| 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 |
$619.65
|
| Rate for Payer: Global Benefits Group Commercial |
$437.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$656.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$546.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$486.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.80
|
| 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 |
$546.75
|
| Rate for Payer: Networks By Design Commercial |
$473.85
|
| Rate for Payer: Prime Health Services Commercial |
$619.65
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$437.40
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$437.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$437.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.50
|
| Rate for Payer: United Healthcare All Other HMO |
$364.50
|
| Rate for Payer: United Healthcare HMO Rider |
$364.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.50
|
| 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
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.60 |
| Max. Negotiated Rate |
$902.70 |
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Central Health Plan Commercial |
$802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$902.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.60
|
| Rate for Payer: Multiplan Commercial |
$752.25
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
|
|
HC DEST OF LESIONS LT 10 SQ CM
|
Facility
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 17106
|
| Hospital Charge Code |
900501553
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.60 |
| 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: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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: BCBS Transplant Transplant |
$601.80
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Cash Price |
$451.35
|
| Rate for Payer: Central Health Plan Commercial |
$802.40
|
| Rate for Payer: Cigna of CA PPO |
$742.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$852.55
|
| Rate for Payer: Global Benefits Group Commercial |
$601.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$902.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$752.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$752.25
|
| Rate for Payer: Networks By Design Commercial |
$651.95
|
| Rate for Payer: Prime Health Services Commercial |
$852.55
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$601.80
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$601.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$501.50
|
| Rate for Payer: United Healthcare All Other HMO |
$501.50
|
| Rate for Payer: United Healthcare HMO Rider |
$501.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC DESTRCTN VAGNL LESION OR LSNS SMPL
|
Facility
OP
|
$7,842.00
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
909000061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.40 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,705.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,528.90
|
| Rate for Payer: Cash Price |
$3,528.90
|
| Rate for Payer: Cash Price |
$3,528.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,273.60
|
| Rate for Payer: Cigna of CA PPO |
$5,803.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| 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 |
$6,665.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,705.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,057.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,881.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$6,445.20
|
| Rate for Payer: 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 |
$5,230.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,568.40
|
| 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 |
$5,881.50
|
| Rate for Payer: Networks By Design Commercial |
$5,097.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,665.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,705.20
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,705.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| 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 DESTRCTN VAGNL LESION OR LSNS SMPL
|
Facility
IP
|
$7,842.00
|
|
|
Service Code
|
CPT 57061
|
| Hospital Charge Code |
909000061
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,568.40 |
| Max. Negotiated Rate |
$7,057.80 |
| Rate for Payer: Cash Price |
$3,528.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,273.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,136.80
|
| Rate for Payer: Galaxy Health WC |
$6,665.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,705.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,057.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,230.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,568.40
|
| Rate for Payer: Multiplan Commercial |
$5,881.50
|
| Rate for Payer: Networks By Design Commercial |
$5,097.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,665.70
|
|
|
HC DESTROY INTERNAL HEMORRHOIDS
|
Facility
OP
|
$3,628.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
906746930
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,474.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,474.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,176.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,474.42
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,902.40
|
| Rate for Payer: Cigna of CA PPO |
$2,684.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,990.47
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,474.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,474.42
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,265.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,721.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,418.05
|
| Rate for Payer: IEHP medi-cal |
$2,432.79
|
| Rate for Payer: IEHP Medicare Advantage |
$1,474.42
|
| Rate for Payer: Innovage PACE Commercial |
$2,211.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,474.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,975.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,975.72
|
| Rate for Payer: Multiplan Commercial |
$2,721.00
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,562.89
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,621.86
|
| Rate for Payer: Riverside University Health MISP |
$1,621.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,176.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,769.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,474.42
|
|
|
HC DESTROY INTERNAL HEMORRHOIDS
|
Facility
IP
|
$3,628.00
|
|
|
Service Code
|
CPT 46930
|
| Hospital Charge Code |
906746930
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$725.60 |
| Max. Negotiated Rate |
$3,265.20 |
| Rate for Payer: Cash Price |
$1,632.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,902.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,451.20
|
| Rate for Payer: Galaxy Health WC |
$3,083.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,176.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,265.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,419.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.60
|
| Rate for Payer: Multiplan Commercial |
$2,721.00
|
| Rate for Payer: Networks By Design Commercial |
$2,358.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,083.80
|
|
|
HC DESTRUCTION ANAL LESION(S)
|
Facility
OP
|
$4,823.00
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
904000013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$964.60 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,893.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,033.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,358.45
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,858.40
|
| Rate for Payer: Cigna of CA HMO |
$3,086.72
|
| Rate for Payer: Cigna of CA PPO |
$3,569.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,099.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,893.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,340.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,617.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,216.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$3,617.25
|
| Rate for Payer: Networks By Design Commercial |
$3,134.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,099.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,893.80
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,893.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,893.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,411.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,411.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,411.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,411.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC DESTRUCTION ANAL LESION(S)
|
Facility
IP
|
$4,823.00
|
|
|
Service Code
|
CPT 46910
|
| Hospital Charge Code |
904000013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$964.60 |
| Max. Negotiated Rate |
$4,340.70 |
| Rate for Payer: Cash Price |
$2,170.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,858.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,929.20
|
| Rate for Payer: Galaxy Health WC |
$4,099.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,893.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,340.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,216.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$964.60
|
| Rate for Payer: Multiplan Commercial |
$3,617.25
|
| Rate for Payer: Networks By Design Commercial |
$3,134.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,099.55
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$163.90
|
| 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: BCBS Transplant Transplant |
$178.80
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$223.50
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: Riverside University Health MISP |
$119.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$149.00
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC DETERMINATION/VENOUS PRESSURE
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 93770
|
| Hospital Charge Code |
900501622
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$678.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$740.40
|
| 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 |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$789.76
|
| Rate for Payer: Cigna of CA PPO |
$913.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$925.50
|
| Rate for Payer: IEHP medi-cal |
$431.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: Riverside University Health MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| 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 |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT OT
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905104361
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$678.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$740.40
|
| 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 |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$789.76
|
| Rate for Payer: Cigna of CA PPO |
$913.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$925.50
|
| Rate for Payer: IEHP medi-cal |
$431.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: Riverside University Health MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| 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 |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT PT
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905103400
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
905601810
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$678.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$740.40
|
| 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 |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$789.76
|
| Rate for Payer: Cigna of CA PPO |
$913.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$925.50
|
| Rate for Payer: IEHP medi-cal |
$431.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: Riverside University Health MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| 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 |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$678.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$740.40
|
| 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 |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$789.76
|
| Rate for Payer: Cigna of CA PPO |
$913.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$925.50
|
| Rate for Payer: IEHP medi-cal |
$431.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: Riverside University Health MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| 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 |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
|
HC DEVELOP TESTING W/INTERP & RPT ST MCAL
|
Facility
IP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
907000009
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$246.80 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$246.80
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
|
|
HC DEVELOP TEST W INTERP & RPT MCAL
|
Facility
OP
|
$1,234.00
|
|
|
Service Code
|
CPT 96110
|
| Hospital Charge Code |
901300035
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.59 |
| Max. Negotiated Rate |
$1,110.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$48.59
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,048.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$678.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$678.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$349.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$740.40
|
| 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 |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Cash Price |
$555.30
|
| Rate for Payer: Central Health Plan Commercial |
$987.20
|
| Rate for Payer: Cigna of CA HMO |
$789.76
|
| Rate for Payer: Cigna of CA PPO |
$913.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,048.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$493.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$493.60
|
| Rate for Payer: Galaxy Health WC |
$1,048.90
|
| Rate for Payer: Global Benefits Group Commercial |
$740.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,110.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$925.50
|
| Rate for Payer: IEHP medi-cal |
$431.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$823.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$505.94
|
| Rate for Payer: Multiplan Commercial |
$925.50
|
| Rate for Payer: Networks By Design Commercial |
$802.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,048.90
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$740.40
|
| Rate for Payer: Riverside University Health MISP |
$493.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$740.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$740.40
|
| 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 |
$1,048.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,048.90
|
|
