|
HC GLUCOSE TOLERANCE TEST 2 HR
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$114.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.22
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Media |
$12.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: InnovAge PACE Commercial |
$19.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE TOLERANCE TEST 3 HR
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$114.22 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$114.22
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Media |
$12.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: InnovAge PACE Commercial |
$19.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC GLUCOSE TOLERANCE TEST 3 HR
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
900910308
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$40.80 |
| Max. Negotiated Rate |
$183.60 |
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Central Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.60
|
| Rate for Payer: Galaxy Health WC |
$173.40
|
| Rate for Payer: Global Benefits Group Commercial |
$122.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$153.00
|
| Rate for Payer: Networks By Design Commercial |
$132.60
|
| Rate for Payer: Prime Health Services Commercial |
$173.40
|
|
|
HC GLUCOSE URINE
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC GLUCOSE URINE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900910311
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.77
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California EPN |
$7.78
|
| Rate for Payer: Caremore Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Media |
$3.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: InnovAge PACE Commercial |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$4.17
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE URINE 24 HOURS
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.77
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California EPN |
$7.78
|
| Rate for Payer: Caremore Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Media |
$3.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: InnovAge PACE Commercial |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$4.17
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUCOSE URINE 24 HOURS
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912205
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC GLUCOSE URINE RANDOM
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$44.10 |
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC GLUCOSE URINE RANDOM
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
900912204
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.19 |
| Max. Negotiated Rate |
$34.77 |
| Rate for Payer: Adventist Health Medi-Cal |
$3.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.77
|
| Rate for Payer: Blue Distinction Transplant |
$9.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9.89
|
| Rate for Payer: Blue Shield of California EPN |
$7.78
|
| Rate for Payer: Caremore Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Central Health Plan Commercial |
$12.80
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.90
|
| Rate for Payer: Dignity Health Media |
$3.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.93
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.93
|
| Rate for Payer: InnovAge PACE Commercial |
$5.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Medicare |
$4.17
|
| Rate for Payer: Riverside University Health System MISP |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.19
|
| Rate for Payer: United Healthcare All Other HMO |
$3.19
|
| Rate for Payer: United Healthcare HMO Rider |
$3.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$3.93
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
905352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$91.54 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$128.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.56
|
| Rate for Payer: Blue Distinction Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$198.75
|
| Rate for Payer: Blue Shield of California EPN |
$144.16
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Media |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$92.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$91.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.65
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Riverside University Health System MISP |
$106.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC GLUTEAL PAD EA ADD. LE
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT L2650
|
| Hospital Charge Code |
905352650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$238.50 |
| Rate for Payer: Blue Shield of California EPN |
$141.51
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Central Health Plan Commercial |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$185.50
|
| Rate for Payer: Cigna of CA PPO |
$185.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$238.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.00
|
| Rate for Payer: Multiplan Commercial |
$198.75
|
| Rate for Payer: Networks By Design Commercial |
$132.50
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$100.06
|
| Rate for Payer: United Healthcare All Other HMO |
$97.73
|
| Rate for Payer: United Healthcare HMO Rider |
$95.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.45
|
|
|
HC GRAFIX CORE 5X5
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$980.61 |
| Rate for Payer: Aetna of CA HMO/PPO |
$980.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$211.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$211.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.68
|
| Rate for Payer: Blue Distinction Transplant |
$231.00
|
| Rate for Payer: Blue Shield of California Commercial |
$242.16
|
| Rate for Payer: Blue Shield of California EPN |
$188.26
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.25
|
| Rate for Payer: Dignity Health Media |
$327.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$327.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$288.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Riverside University Health System MISP |
$154.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$192.50
|
| Rate for Payer: United Healthcare All Other HMO |
$192.50
|
| Rate for Payer: United Healthcare HMO Rider |
$192.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$192.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Vantage Medical Group Senior |
$327.25
|
|
|
HC GRAFIX CORE 5X5
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT Q4132
|
| Hospital Charge Code |
900101472
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Blue Shield of California Commercial |
$288.75
|
| Rate for Payer: Blue Shield of California EPN |
$205.59
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$145.38
|
| Rate for Payer: United Healthcare All Other HMO |
$141.99
|
| Rate for Payer: United Healthcare HMO Rider |
$138.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.05
|
|
|
HC GRAFIX PRIME 3X4
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Blue Shield of California Commercial |
$312.00
|
| Rate for Payer: Blue Shield of California EPN |
$222.14
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$277.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.08
|
| Rate for Payer: United Healthcare All Other HMO |
$153.42
|
| Rate for Payer: United Healthcare HMO Rider |
$150.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.28
|
|
|
HC GRAFIX PRIME 3X4
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101475
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$844.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$844.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.68
|
| Rate for Payer: Blue Distinction Transplant |
$249.60
|
| Rate for Payer: Blue Shield of California Commercial |
$261.66
|
| Rate for Payer: Blue Shield of California EPN |
$203.42
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$291.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Media |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$277.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: Riverside University Health System MISP |
$166.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$208.00
|
| Rate for Payer: United Healthcare HMO Rider |
$208.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC GRAFIX PRIME 5X5
|
Facility
|
IP
|
$416.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$374.40 |
| Rate for Payer: Blue Shield of California Commercial |
$312.00
|
| Rate for Payer: Blue Shield of California EPN |
$222.14
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$291.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$277.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$158.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.08
|
| Rate for Payer: United Healthcare All Other HMO |
$153.42
|
| Rate for Payer: United Healthcare HMO Rider |
$150.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.28
|
|
|
HC GRAFIX PRIME 5X5
|
Facility
|
OP
|
$416.00
|
|
|
Service Code
|
CPT Q4133
|
| Hospital Charge Code |
900101474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.20 |
| Max. Negotiated Rate |
$844.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$844.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$353.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$228.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$291.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.68
|
| Rate for Payer: Blue Distinction Transplant |
$249.60
|
| Rate for Payer: Blue Shield of California Commercial |
$261.66
|
| Rate for Payer: Blue Shield of California EPN |
$203.42
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Central Health Plan Commercial |
$332.80
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$291.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$353.60
|
| Rate for Payer: Dignity Health Media |
$353.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$166.40
|
| Rate for Payer: Galaxy Health WC |
$353.60
|
| Rate for Payer: Global Benefits Group Commercial |
$249.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$374.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$312.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$141.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$277.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.20
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$353.60
|
| Rate for Payer: Riverside University Health System MISP |
$166.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$249.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$249.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$208.00
|
| Rate for Payer: United Healthcare HMO Rider |
$208.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$208.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.60
|
| Rate for Payer: Vantage Medical Group Senior |
$353.60
|
|
|
HC GRAFT APLIGRAF 7.5 CM
|
Facility
|
OP
|
$520.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
900101456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.63 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$67.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.44
|
| Rate for Payer: Blue Distinction Transplant |
$312.00
|
| Rate for Payer: Blue Shield of California Commercial |
$327.08
|
| Rate for Payer: Blue Shield of California EPN |
$254.28
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.00
|
| Rate for Payer: Dignity Health Media |
$442.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$442.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$390.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: Riverside University Health System MISP |
$208.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$312.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$312.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.00
|
| Rate for Payer: United Healthcare All Other HMO |
$260.00
|
| Rate for Payer: United Healthcare HMO Rider |
$260.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$260.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$442.00
|
| Rate for Payer: Vantage Medical Group Senior |
$442.00
|
|
|
HC GRAFT APLIGRAF 7.5 CM
|
Facility
|
IP
|
$520.00
|
|
|
Service Code
|
CPT Q4101
|
| Hospital Charge Code |
900101456
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$104.00 |
| Max. Negotiated Rate |
$468.00 |
| Rate for Payer: Blue Shield of California Commercial |
$390.00
|
| Rate for Payer: Blue Shield of California EPN |
$277.68
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Central Health Plan Commercial |
$416.00
|
| Rate for Payer: Cigna of CA HMO |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$208.00
|
| Rate for Payer: Galaxy Health WC |
$442.00
|
| Rate for Payer: Global Benefits Group Commercial |
$312.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$468.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.00
|
| Rate for Payer: Multiplan Commercial |
$390.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$442.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$196.35
|
| Rate for Payer: United Healthcare All Other HMO |
$191.78
|
| Rate for Payer: United Healthcare HMO Rider |
$187.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$171.60
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
|
OP
|
$7,462.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,715.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,477.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$3,357.90
|
| Rate for Payer: Cash Price |
$3,357.90
|
| Rate for Payer: Cash Price |
$3,357.90
|
| Rate for Payer: Cash Price |
$3,357.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,969.60
|
| Rate for Payer: Cigna of CA PPO |
$5,521.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$6,342.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,477.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,715.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,596.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,977.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,492.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$5,596.50
|
| Rate for Payer: Networks By Design Commercial |
$4,850.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,342.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,477.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,731.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,731.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,731.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC GRAFT COMPOSITE EAR OR NASAL
|
Facility
|
IP
|
$7,462.00
|
|
|
Service Code
|
CPT 15760
|
| Hospital Charge Code |
900515760
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,492.40 |
| Max. Negotiated Rate |
$6,715.80 |
| Rate for Payer: Cash Price |
$3,357.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,969.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,984.80
|
| Rate for Payer: Galaxy Health WC |
$6,342.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,477.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,715.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,977.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,843.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,492.40
|
| Rate for Payer: Multiplan Commercial |
$5,596.50
|
| Rate for Payer: Networks By Design Commercial |
$4,850.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,342.70
|
|
|
HC GRAFT DERMA-FAT-FASCIA
|
Facility
|
IP
|
$6,195.00
|
|
|
Service Code
|
CPT 15770
|
| Hospital Charge Code |
900501750
|
|
Hospital Revenue Code
|
451
|
| Min. Negotiated Rate |
$1,239.00 |
| Max. Negotiated Rate |
$5,575.50 |
| Rate for Payer: Cash Price |
$2,787.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,956.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,478.00
|
| Rate for Payer: Galaxy Health WC |
$5,265.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,717.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,575.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,132.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,360.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,239.00
|
| Rate for Payer: Multiplan Commercial |
$4,646.25
|
| Rate for Payer: Networks By Design Commercial |
$4,026.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,265.75
|
|
|
HC GRAFT DERMA-FAT-FASCIA
|
Facility
|
OP
|
$6,195.00
|
|
|
Service Code
|
CPT 15770
|
| Hospital Charge Code |
900501750
|
|
Hospital Revenue Code
|
451
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,482.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,717.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,482.50
|
| Rate for Payer: Cash Price |
$2,787.75
|
| Rate for Payer: Cash Price |
$2,787.75
|
| Rate for Payer: Cash Price |
$2,787.75
|
| Rate for Payer: Cash Price |
$2,787.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,956.00
|
| Rate for Payer: Cigna of CA PPO |
$4,584.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Dignity Health Media |
$4,482.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,930.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,051.38
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,482.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,482.50
|
| Rate for Payer: Galaxy Health WC |
$5,265.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,717.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,575.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,646.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,351.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,482.50
|
| Rate for Payer: InnovAge PACE Commercial |
$6,723.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,132.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,482.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,239.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,006.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,006.55
|
| Rate for Payer: Multiplan Commercial |
$4,646.25
|
| Rate for Payer: Networks By Design Commercial |
$4,026.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,265.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,751.45
|
| Rate for Payer: Riverside University Health System MISP |
$4,930.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,717.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,717.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,097.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,097.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,097.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,097.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,723.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,930.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,482.50
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906811413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$90.50 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$470.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$626.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$405.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$405.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$442.20
|
| 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 |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: Cigna of CA PPO |
$545.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$626.45
|
| Rate for Payer: Dignity Health Media |
$626.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$626.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$552.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$257.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.40
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
| Rate for Payer: Riverside University Health System MISP |
$294.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$442.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$442.20
|
| 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 |
$626.45
|
| Rate for Payer: Vantage Medical Group Senior |
$626.45
|
|
|
HC GRAFT, IM, CONDUIT
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 93564
|
| Hospital Charge Code |
906811413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$147.40 |
| Max. Negotiated Rate |
$663.30 |
| Rate for Payer: Cash Price |
$331.65
|
| Rate for Payer: Central Health Plan Commercial |
$589.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.80
|
| Rate for Payer: Galaxy Health WC |
$626.45
|
| Rate for Payer: Global Benefits Group Commercial |
$442.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$663.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$491.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$280.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$147.40
|
| Rate for Payer: Multiplan Commercial |
$552.75
|
| Rate for Payer: Networks By Design Commercial |
$479.05
|
| Rate for Payer: Prime Health Services Commercial |
$626.45
|
|
