|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
|
IP
|
$2,146.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.20 |
| Max. Negotiated Rate |
$1,931.40 |
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,716.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$858.40
|
| Rate for Payer: Galaxy Health WC |
$1,824.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,931.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,431.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$817.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.20
|
| Rate for Payer: Multiplan Commercial |
$1,609.50
|
| Rate for Payer: Networks By Design Commercial |
$1,394.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,824.10
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
|
OP
|
$2,146.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.20 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,287.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,716.80
|
| Rate for Payer: Cigna of CA PPO |
$1,588.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,824.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,931.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,609.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,431.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,609.50
|
| Rate for Payer: Networks By Design Commercial |
$1,394.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,824.10
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,287.60
|
| 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 |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/MR GDN EA ADDL LSN
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 10012
|
| Hospital Charge Code |
909010012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.60 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Central Health Plan Commercial |
$858.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.20
|
| Rate for Payer: Galaxy Health WC |
$912.05
|
| Rate for Payer: Global Benefits Group Commercial |
$643.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$965.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.60
|
| Rate for Payer: Multiplan Commercial |
$804.75
|
| Rate for Payer: Networks By Design Commercial |
$697.45
|
| Rate for Payer: Prime Health Services Commercial |
$912.05
|
|
|
HC FNA BX W/MR GDN EA ADDL LSN
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 10012
|
| Hospital Charge Code |
909010012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.60 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$643.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Central Health Plan Commercial |
$858.40
|
| Rate for Payer: Cigna of CA PPO |
$794.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.05
|
| Rate for Payer: Dignity Health Media |
$912.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$429.20
|
| Rate for Payer: Galaxy Health WC |
$912.05
|
| Rate for Payer: Global Benefits Group Commercial |
$643.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$965.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$804.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$375.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.60
|
| Rate for Payer: Multiplan Commercial |
$804.75
|
| Rate for Payer: Networks By Design Commercial |
$697.45
|
| Rate for Payer: Prime Health Services Commercial |
$912.05
|
| Rate for Payer: Riverside University Health System MISP |
$429.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$643.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.05
|
| Rate for Payer: Vantage Medical Group Senior |
$912.05
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$2,146.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$212.21 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,287.60
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,716.80
|
| Rate for Payer: Cigna of CA PPO |
$1,588.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,824.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,931.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,609.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,431.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,609.50
|
| Rate for Payer: Networks By Design Commercial |
$1,394.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,824.10
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,287.60
|
| 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 |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$2,146.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$429.20 |
| Max. Negotiated Rate |
$1,931.40 |
| Rate for Payer: Cash Price |
$965.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,716.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$858.40
|
| Rate for Payer: Galaxy Health WC |
$1,824.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,287.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,931.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,431.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$817.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.20
|
| Rate for Payer: Multiplan Commercial |
$1,609.50
|
| Rate for Payer: Networks By Design Commercial |
$1,394.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,824.10
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
IP
|
$1,073.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$214.60 |
| Max. Negotiated Rate |
$965.70 |
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Central Health Plan Commercial |
$858.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.20
|
| Rate for Payer: Galaxy Health WC |
$912.05
|
| Rate for Payer: Global Benefits Group Commercial |
$643.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$965.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.60
|
| Rate for Payer: Multiplan Commercial |
$804.75
|
| Rate for Payer: Networks By Design Commercial |
$697.45
|
| Rate for Payer: Prime Health Services Commercial |
$912.05
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
OP
|
$1,073.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.32 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$912.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$643.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Cash Price |
$482.85
|
| Rate for Payer: Central Health Plan Commercial |
$858.40
|
| Rate for Payer: Cigna of CA PPO |
$794.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$912.05
|
| Rate for Payer: Dignity Health Media |
$912.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$912.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$429.20
|
| Rate for Payer: Galaxy Health WC |
$912.05
|
| Rate for Payer: Global Benefits Group Commercial |
$643.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$965.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$804.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$375.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$715.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.60
|
| Rate for Payer: Multiplan Commercial |
$804.75
|
| Rate for Payer: Networks By Design Commercial |
$697.45
|
| Rate for Payer: Prime Health Services Commercial |
$912.05
|
| Rate for Payer: Riverside University Health System MISP |
$429.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$643.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$912.05
|
| Rate for Payer: Vantage Medical Group Senior |
$912.05
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$388.76 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$388.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.02
|
| Rate for Payer: Blue Distinction Transplant |
$93.60
|
| Rate for Payer: Blue Shield of California Commercial |
$96.41
|
| Rate for Payer: Blue Shield of California EPN |
$75.82
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$111.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: InnovAge PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Riverside University Health System MISP |
$74.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC FO FINGER KNUCKLE BENDER PF
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905103948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$333.90 |
| Rate for Payer: Blue Shield of California EPN |
$198.11
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Central Health Plan Commercial |
$296.80
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: Networks By Design Commercial |
$185.50
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$140.09
|
| Rate for Payer: United Healthcare All Other HMO |
$136.82
|
| Rate for Payer: United Healthcare HMO Rider |
$133.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.43
|
|
|
HC FO FINGER KNUCKLE BENDER PF
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905103948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.00 |
| Max. Negotiated Rate |
$333.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.19
|
| Rate for Payer: Blue Distinction Transplant |
$222.60
|
| Rate for Payer: Blue Shield of California Commercial |
$278.25
|
| Rate for Payer: Blue Shield of California EPN |
$201.82
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Central Health Plan Commercial |
$296.80
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.35
|
| Rate for Payer: Dignity Health Media |
$315.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$278.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$129.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.11
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: Networks By Design Commercial |
$185.50
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: Riverside University Health System MISP |
$148.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.50
|
| Rate for Payer: United Healthcare All Other HMO |
$185.50
|
| Rate for Payer: United Healthcare HMO Rider |
$185.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.35
|
| Rate for Payer: Vantage Medical Group Senior |
$315.35
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
905353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Blue Shield of California EPN |
$236.03
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Central Health Plan Commercial |
$353.60
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.40
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.90
|
| Rate for Payer: United Healthcare All Other HMO |
$163.01
|
| Rate for Payer: United Healthcare HMO Rider |
$159.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.86
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
905353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$154.70 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$243.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$214.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.13
|
| Rate for Payer: Blue Distinction Transplant |
$265.20
|
| Rate for Payer: Blue Shield of California Commercial |
$331.50
|
| Rate for Payer: Blue Shield of California EPN |
$240.45
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Central Health Plan Commercial |
$353.60
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.70
|
| Rate for Payer: Dignity Health Media |
$375.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$331.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$154.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.22
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Riverside University Health System MISP |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$221.00
|
| Rate for Payer: United Healthcare All Other HMO |
$221.00
|
| Rate for Payer: United Healthcare HMO Rider |
$221.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$221.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.70
|
| Rate for Payer: Vantage Medical Group Senior |
$375.70
|
|
|
HC FO INSERT PLASTIZOTE
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
905353002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.50 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.88
|
| Rate for Payer: Blue Distinction Transplant |
$138.00
|
| Rate for Payer: Blue Shield of California Commercial |
$172.50
|
| Rate for Payer: Blue Shield of California EPN |
$125.12
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Media |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$172.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.00
|
| Rate for Payer: United Healthcare All Other HMO |
$115.00
|
| Rate for Payer: United Healthcare HMO Rider |
$115.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC FO INSERT PLASTIZOTE
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
905353002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Blue Shield of California EPN |
$122.82
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.85
|
| Rate for Payer: United Healthcare All Other HMO |
$84.82
|
| Rate for Payer: United Healthcare HMO Rider |
$82.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.90
|
|
|
HC FO INSERT UCBL TYPE
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
905353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$242.90 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.02
|
| Rate for Payer: Blue Distinction Transplant |
$416.40
|
| Rate for Payer: Blue Shield of California Commercial |
$520.50
|
| Rate for Payer: Blue Shield of California EPN |
$377.54
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.90
|
| Rate for Payer: Dignity Health Media |
$589.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$520.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$242.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.54
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Networks By Design Commercial |
$347.00
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Riverside University Health System MISP |
$277.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$347.00
|
| Rate for Payer: United Healthcare All Other HMO |
$347.00
|
| Rate for Payer: United Healthcare HMO Rider |
$347.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$347.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.90
|
| Rate for Payer: Vantage Medical Group Senior |
$589.90
|
|
|
HC FO INSERT UCBL TYPE
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
905353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Blue Shield of California EPN |
$370.60
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.80
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Networks By Design Commercial |
$347.00
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.05
|
| Rate for Payer: United Healthcare All Other HMO |
$255.95
|
| Rate for Payer: United Healthcare HMO Rider |
$250.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$229.02
|
|
|
HC FOLEY CATH INSERTION TRAY PVP
|
Facility
|
OP
|
$22.30
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.31 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.17
|
| Rate for Payer: Blue Distinction Transplant |
$13.38
|
| Rate for Payer: Blue Shield of California Commercial |
$14.03
|
| Rate for Payer: Blue Shield of California EPN |
$10.90
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Central Health Plan Commercial |
$17.84
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$16.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.96
|
| Rate for Payer: Dignity Health Media |
$18.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.92
|
| Rate for Payer: Galaxy Health WC |
$18.96
|
| Rate for Payer: Global Benefits Group Commercial |
$13.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$16.72
|
| Rate for Payer: Networks By Design Commercial |
$14.50
|
| Rate for Payer: Prime Health Services Commercial |
$18.96
|
| Rate for Payer: Riverside University Health System MISP |
$8.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.15
|
| Rate for Payer: United Healthcare All Other HMO |
$11.15
|
| Rate for Payer: United Healthcare HMO Rider |
$11.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.96
|
| Rate for Payer: Vantage Medical Group Senior |
$18.96
|
|
|
HC FOLEY CATH INSERTION TRAY PVP
|
Facility
|
IP
|
$22.30
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Central Health Plan Commercial |
$17.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: Galaxy Health WC |
$18.96
|
| Rate for Payer: Global Benefits Group Commercial |
$13.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$16.72
|
| Rate for Payer: Networks By Design Commercial |
$14.50
|
| Rate for Payer: Prime Health Services Commercial |
$18.96
|
|
|
HC FOLEY TRAY
|
Facility
|
IP
|
$85.80
|
|
| Hospital Charge Code |
906812274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Central Health Plan Commercial |
$68.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.93
|
| Rate for Payer: Global Benefits Group Commercial |
$51.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
| Rate for Payer: Networks By Design Commercial |
$55.77
|
| Rate for Payer: Prime Health Services Commercial |
$72.93
|
|
|
HC FOLEY TRAY
|
Facility
|
OP
|
$85.80
|
|
| Hospital Charge Code |
906812274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.69
|
| Rate for Payer: Blue Distinction Transplant |
$51.48
|
| Rate for Payer: Blue Shield of California Commercial |
$53.97
|
| Rate for Payer: Blue Shield of California EPN |
$41.96
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Central Health Plan Commercial |
$68.64
|
| Rate for Payer: Cigna of CA HMO |
$54.91
|
| Rate for Payer: Cigna of CA PPO |
$63.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.93
|
| Rate for Payer: Dignity Health Media |
$72.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.93
|
| Rate for Payer: Global Benefits Group Commercial |
$51.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$64.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
| Rate for Payer: Networks By Design Commercial |
$55.77
|
| Rate for Payer: Prime Health Services Commercial |
$72.93
|
| Rate for Payer: Riverside University Health System MISP |
$34.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.90
|
| Rate for Payer: United Healthcare All Other HMO |
$42.90
|
| Rate for Payer: United Healthcare HMO Rider |
$42.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.93
|
| Rate for Payer: Vantage Medical Group Senior |
$72.93
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$130.47 |
| Rate for Payer: Adventist Health Medi-Cal |
$14.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.47
|
| Rate for Payer: Blue Distinction Transplant |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$17.30
|
| Rate for Payer: Blue Shield of California EPN |
$13.61
|
| Rate for Payer: Caremore Medicare Advantage |
$14.70
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Central Health Plan Commercial |
$22.40
|
| Rate for Payer: Cigna of CA HMO |
$17.92
|
| Rate for Payer: Cigna of CA PPO |
$20.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: Dignity Health Media |
$14.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$14.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.70
|
| Rate for Payer: Galaxy Health WC |
$23.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.70
|
| Rate for Payer: InnovAge PACE Commercial |
$22.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.70
|
| Rate for Payer: Multiplan Commercial |
$21.00
|
| Rate for Payer: Networks By Design Commercial |
$18.20
|
| Rate for Payer: Prime Health Services Commercial |
$23.80
|
| Rate for Payer: Prime Health Services Medicare |
$15.58
|
| Rate for Payer: Riverside University Health System MISP |
$16.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$16.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.91
|
| Rate for Payer: United Healthcare All Other HMO |
$11.91
|
| Rate for Payer: United Healthcare HMO Rider |
$11.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$14.70
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
OP
|
$2,676.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$6,571.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,982.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$425.02
|
| 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 |
$187.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.74
|
| Rate for Payer: Blue Distinction Transplant |
$1,605.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,653.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,300.54
|
| Rate for Payer: Caremore Medicare Advantage |
$3,982.55
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Cash Price |
$1,204.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,140.80
|
| Rate for Payer: Cigna of CA HMO |
$1,712.64
|
| Rate for Payer: Cigna of CA PPO |
$1,980.24
|
| 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 |
$2,274.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,605.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,408.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,007.00
|
| 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 |
$1,784.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,982.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.20
|
| 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 |
$2,007.00
|
| Rate for Payer: Networks By Design Commercial |
$1,739.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,274.60
|
| 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 |
$1,605.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,605.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| 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
|
|
