|
HC MARCH BAR, SHOE ADD
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
905353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Blue Shield of California EPN |
$43.79
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC MARSUPIALIZATION OF BARTHOLINS GLAND CYST
|
Facility
OP
|
$6,301.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
900556440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,406.14 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$3,780.60
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$2,835.45
|
| Rate for Payer: Cash Price |
$2,835.45
|
| Rate for Payer: Cash Price |
$2,835.45
|
| Rate for Payer: Cash Price |
$2,835.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,040.80
|
| Rate for Payer: Cigna of CA PPO |
$4,662.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$5,355.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,780.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,670.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$4,725.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$3,906.18
|
| Rate for Payer: Innovage PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,202.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$4,725.75
|
| Rate for Payer: Networks By Design Commercial |
$4,095.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,355.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$3,780.60
|
| Rate for Payer: Riverside University Health MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,780.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,150.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,150.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,150.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,150.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC MARSUPIALIZATION OF BARTHOLINS GLAND CYST
|
Facility
IP
|
$6,301.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
900556440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,260.20 |
| Max. Negotiated Rate |
$5,670.90 |
| Rate for Payer: Cash Price |
$2,835.45
|
| Rate for Payer: Central Health Plan Commercial |
$5,040.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,520.40
|
| Rate for Payer: Galaxy Health WC |
$5,355.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,780.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,670.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,202.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,260.20
|
| Rate for Payer: Multiplan Commercial |
$4,725.75
|
| Rate for Payer: Networks By Design Commercial |
$4,095.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,355.85
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
901300056
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$133.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$145.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$181.50
|
| Rate for Payer: IEHP medi-cal |
$84.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.22
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: Riverside University Health MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
901300056
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$133.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$145.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$181.50
|
| Rate for Payer: IEHP medi-cal |
$84.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.22
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: Riverside University Health MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC MASSAGE 15 MIN OT
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905104145
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$133.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$145.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$181.50
|
| Rate for Payer: IEHP medi-cal |
$84.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.22
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: Riverside University Health MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC MASSAGE 15 MIN OT
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905104145
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC MASSAGE 15 MIN PT
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905103145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$133.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$145.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$181.50
|
| Rate for Payer: IEHP medi-cal |
$84.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.22
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: Riverside University Health MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC MASSAGE 15 MIN PT
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
905103145
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC MASSAGE 15 MIN PT COMM MCARE
|
Facility
IP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900417124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$217.80 |
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.40
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
|
|
HC MASSAGE 15 MIN PT COMM MCARE
|
Facility
OP
|
$242.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900417124
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$84.70 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$100.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$205.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$133.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$133.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: BCBS Transplant Transplant |
$145.20
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Central Health Plan Commercial |
$193.60
|
| Rate for Payer: Cigna of CA HMO |
$154.88
|
| Rate for Payer: Cigna of CA PPO |
$179.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$205.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$96.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$96.80
|
| Rate for Payer: Galaxy Health WC |
$205.70
|
| Rate for Payer: Global Benefits Group Commercial |
$145.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$217.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$181.50
|
| Rate for Payer: IEHP medi-cal |
$84.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$161.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.22
|
| Rate for Payer: Multiplan Commercial |
$181.50
|
| Rate for Payer: Networks By Design Commercial |
$157.30
|
| Rate for Payer: Prime Health Services Commercial |
$205.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: Riverside University Health MISP |
$96.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$205.70
|
| Rate for Payer: Vantage Medical Group Senior |
$205.70
|
|
|
HC MASTOID CHILD
|
Facility
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.69 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$146.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.83
|
| Rate for Payer: BCBS Transplant Transplant |
$621.60
|
| Rate for Payer: Blue Shield of California Commercial |
$640.25
|
| Rate for Payer: Blue Shield of California EPN |
$503.50
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Central Health Plan Commercial |
$828.80
|
| Rate for Payer: Cigna of CA HMO |
$663.04
|
| Rate for Payer: Cigna of CA PPO |
$766.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$932.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$777.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$777.00
|
| Rate for Payer: Networks By Design Commercial |
$673.40
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$621.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC MASTOID CHILD
|
Facility
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Central Health Plan Commercial |
$828.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.40
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$932.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$777.00
|
| Rate for Payer: Networks By Design Commercial |
$673.40
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
|
|
HC MASTOID COMPLETE
|
Facility
OP
|
$1,036.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.69 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$222.54
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.49
|
| Rate for Payer: BCBS Transplant Transplant |
$621.60
|
| Rate for Payer: Blue Shield of California Commercial |
$640.25
|
| Rate for Payer: Blue Shield of California EPN |
$503.50
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Central Health Plan Commercial |
$828.80
|
| Rate for Payer: Cigna of CA HMO |
$663.04
|
| Rate for Payer: Cigna of CA PPO |
$766.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$932.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$777.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$777.00
|
| Rate for Payer: Networks By Design Commercial |
$673.40
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$621.60
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC MASTOID COMPLETE
|
Facility
IP
|
$1,036.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.20 |
| Max. Negotiated Rate |
$932.40 |
| Rate for Payer: Cash Price |
$466.20
|
| Rate for Payer: Central Health Plan Commercial |
$828.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.40
|
| Rate for Payer: Galaxy Health WC |
$880.60
|
| Rate for Payer: Global Benefits Group Commercial |
$621.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$932.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$777.00
|
| Rate for Payer: Networks By Design Commercial |
$673.40
|
| Rate for Payer: Prime Health Services Commercial |
$880.60
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
OP
|
$8,370.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,674.00 |
| Max. Negotiated Rate |
$7,533.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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: BCBS Transplant Transplant |
$5,022.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,264.73
|
| Rate for Payer: Blue Shield of California EPN |
$4,092.93
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,696.00
|
| Rate for Payer: Cigna of CA HMO |
$5,356.80
|
| Rate for Payer: Cigna of CA PPO |
$6,193.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$7,114.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,022.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,533.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,277.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,582.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$6,277.50
|
| Rate for Payer: Networks By Design Commercial |
$5,440.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,114.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,022.00
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,022.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,022.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,185.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,185.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,185.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,185.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
IP
|
$8,370.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,674.00 |
| Max. Negotiated Rate |
$7,533.00 |
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,696.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,348.00
|
| Rate for Payer: Galaxy Health WC |
$7,114.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,022.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,533.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,582.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$6,277.50
|
| Rate for Payer: Networks By Design Commercial |
$5,440.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,114.50
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
IP
|
$8,370.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,674.00 |
| Max. Negotiated Rate |
$7,533.00 |
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,696.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,348.00
|
| Rate for Payer: Galaxy Health WC |
$7,114.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,022.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,533.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,582.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$6,277.50
|
| Rate for Payer: Networks By Design Commercial |
$5,440.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,114.50
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
IP
|
$8,370.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,674.00 |
| Max. Negotiated Rate |
$7,533.00 |
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,696.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,348.00
|
| Rate for Payer: Galaxy Health WC |
$7,114.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,022.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,533.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,582.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.00
|
| Rate for Payer: Multiplan Commercial |
$6,277.50
|
| Rate for Payer: Networks By Design Commercial |
$5,440.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,114.50
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
OP
|
$8,370.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,674.00 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,025.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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: BCBS Transplant Transplant |
$5,022.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,696.00
|
| Rate for Payer: Cigna of CA PPO |
$6,193.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$7,114.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,022.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,533.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,277.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$3,342.39
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,582.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$6,277.50
|
| Rate for Payer: Networks By Design Commercial |
$5,440.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,114.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,022.00
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,022.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
OP
|
$8,370.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,533.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,025.69
|
| 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: BCBS Transplant Transplant |
$5,022.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,025.69
|
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Cash Price |
$3,766.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,696.00
|
| Rate for Payer: Cigna of CA PPO |
$6,193.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,038.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,734.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,025.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,025.69
|
| Rate for Payer: Galaxy Health WC |
$7,114.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,022.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,533.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$6,277.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,322.13
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$2,025.69
|
| Rate for Payer: Innovage PACE Commercial |
$3,038.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,582.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,025.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,674.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,714.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,714.42
|
| Rate for Payer: Multiplan Commercial |
$6,277.50
|
| Rate for Payer: Networks By Design Commercial |
$5,440.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,114.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,147.23
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$5,022.00
|
| Rate for Payer: Riverside University Health MISP |
$2,228.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,022.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,185.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,185.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,185.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,185.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,038.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,228.26
|
| Rate for Payer: Vantage Medical Group Senior |
$2,025.69
|
|
|
HC MATRISTEM MICROMATRIX PER 1MG
|
Facility
OP
|
$14.00
|
|
|
Service Code
|
CPT Q4118
|
| Hospital Charge Code |
900101466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.77
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.94
|
| Rate for Payer: BCBS Transplant Transplant |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.81
|
| Rate for Payer: Blue Shield of California EPN |
$6.85
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$9.80
|
| Rate for Payer: Cigna of CA PPO |
$9.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$10.50
|
| Rate for Payer: IEHP medi-cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Riverside University Health MISP |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
HC MATRISTEM MICROMATRIX PER 1MG
|
Facility
IP
|
$14.00
|
|
|
Service Code
|
CPT Q4118
|
| Hospital Charge Code |
900101466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Blue Shield of California Commercial |
$10.50
|
| Rate for Payer: Blue Shield of California EPN |
$7.48
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$9.80
|
| Rate for Payer: Cigna of CA PPO |
$9.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$7.00
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
