|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
915355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$646.77 |
| Max. Negotiated Rate |
$2,084.40 |
| Rate for Payer: Adventist Health Commercial |
$949.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,273.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,737.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,360.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,790.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,167.26
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,852.80
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,968.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,968.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,084.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$646.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,158.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$714.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$949.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,621.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,621.20
|
| Rate for Payer: Multiplan Commercial |
$1,737.00
|
| Rate for Payer: Networks By Design Commercial |
$1,158.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: Riverside University Health System MISP |
$926.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,389.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,389.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,968.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,968.60
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
IP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
905355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$463.20 |
| Max. Negotiated Rate |
$2,084.40 |
| Rate for Payer: Adventist Health Commercial |
$463.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,790.27
|
| Rate for Payer: Blue Shield of California EPN |
$1,167.26
|
| Rate for Payer: Cash Price |
$1,273.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,852.80
|
| Rate for Payer: Cigna of CA HMO |
$1,621.20
|
| Rate for Payer: Cigna of CA PPO |
$1,621.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Senior |
$926.40
|
| Rate for Payer: Galaxy Health WC |
$1,968.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,389.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,084.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,544.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$882.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,433.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$463.20
|
| Rate for Payer: Multiplan Commercial |
$1,737.00
|
| Rate for Payer: Networks By Design Commercial |
$1,505.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,968.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$869.19
|
| Rate for Payer: United Healthcare All Other HMO |
$846.03
|
| Rate for Payer: United Healthcare HMO Rider |
$827.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$758.49
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.50 |
| Max. Negotiated Rate |
$2,643.75 |
| Rate for Payer: Adventist Health Commercial |
$587.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,270.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.50
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,643.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.50
|
| Rate for Payer: Multiplan Commercial |
$2,203.12
|
| Rate for Payer: Networks By Design Commercial |
$1,909.38
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
905380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$962.03 |
| Max. Negotiated Rate |
$2,643.75 |
| Rate for Payer: Adventist Health Commercial |
$1,204.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,725.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,270.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.50
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,496.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,496.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,643.75
|
| Rate for Payer: InnovAge PACE Commercial |
$1,468.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,056.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,056.25
|
| Rate for Payer: Multiplan Commercial |
$2,203.12
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: Riverside University Health System MISP |
$1,175.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Senior |
$2,496.88
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB IP
|
Facility
|
IP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$587.50 |
| Max. Negotiated Rate |
$2,643.75 |
| Rate for Payer: Adventist Health Commercial |
$587.50
|
| Rate for Payer: Blue Shield of California Commercial |
$2,270.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.50
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,643.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.50
|
| Rate for Payer: Multiplan Commercial |
$2,203.12
|
| Rate for Payer: Networks By Design Commercial |
$1,909.38
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
|
|
HC PROS LIVINGSKIN FINGER OR THUMB IP
|
Facility
|
OP
|
$2,937.50
|
|
|
Service Code
|
CPT L7499
|
| Hospital Charge Code |
915380025
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$962.03 |
| Max. Negotiated Rate |
$2,643.75 |
| Rate for Payer: Adventist Health Commercial |
$1,204.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,615.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,203.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,725.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,270.69
|
| Rate for Payer: Blue Shield of California EPN |
$1,480.50
|
| Rate for Payer: Cash Price |
$1,615.63
|
| Rate for Payer: Central Health Plan Commercial |
$2,350.00
|
| Rate for Payer: Cigna of CA HMO |
$2,056.25
|
| Rate for Payer: Cigna of CA PPO |
$2,056.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,496.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,496.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,175.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,175.00
|
| Rate for Payer: Galaxy Health WC |
$2,496.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,762.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,643.75
|
| Rate for Payer: InnovAge PACE Commercial |
$1,468.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,959.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,119.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,818.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,204.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,056.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,056.25
|
| Rate for Payer: Multiplan Commercial |
$2,203.12
|
| Rate for Payer: Networks By Design Commercial |
$1,468.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,496.88
|
| Rate for Payer: Riverside University Health System MISP |
$1,175.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,762.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,762.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,102.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1,073.07
|
| Rate for Payer: United Healthcare HMO Rider |
$1,049.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$962.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,496.88
|
| Rate for Payer: Vantage Medical Group Senior |
$2,496.88
|
|
|
HC PROS SOC INSERT GASKET OR SEAL
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT L7700
|
| Hospital Charge Code |
905357700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$173.25 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$216.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.68
|
| Rate for Payer: Blue Shield of California Commercial |
$408.92
|
| Rate for Payer: Blue Shield of California EPN |
$266.62
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$370.30
|
| Rate for Payer: Cigna of CA PPO |
$370.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: InnovAge PACE Commercial |
$264.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$264.50
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Riverside University Health System MISP |
$211.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.53
|
| Rate for Payer: United Healthcare All Other HMO |
$193.24
|
| Rate for Payer: United Healthcare HMO Rider |
$189.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
|
HC PROS SOC INSERT GASKET OR SEAL
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT L7700
|
| Hospital Charge Code |
905357700
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$476.10 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Blue Shield of California Commercial |
$408.92
|
| Rate for Payer: Blue Shield of California EPN |
$266.62
|
| Rate for Payer: Cash Price |
$290.95
|
| Rate for Payer: Central Health Plan Commercial |
$423.20
|
| Rate for Payer: Cigna of CA HMO |
$370.30
|
| Rate for Payer: Cigna of CA PPO |
$370.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$476.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$198.53
|
| Rate for Payer: United Healthcare All Other HMO |
$193.24
|
| Rate for Payer: United Healthcare HMO Rider |
$189.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.25
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
915358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Blue Shield of California Commercial |
$98.94
|
| Rate for Payer: Blue Shield of California EPN |
$64.51
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
905358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.17
|
| Rate for Payer: Blue Shield of California Commercial |
$98.94
|
| Rate for Payer: Blue Shield of California EPN |
$64.51
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.45
|
| Rate for Payer: InnovAge PACE Commercial |
$64.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Riverside University Health System MISP |
$51.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
905358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.60 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$25.60
|
| Rate for Payer: Blue Shield of California Commercial |
$98.94
|
| Rate for Payer: Blue Shield of California EPN |
$64.51
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$83.20
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
|
|
HC PROS SOCK/SHEATH INC GEL CUSIO
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT L8417
|
| Hospital Charge Code |
915358417
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.92 |
| Max. Negotiated Rate |
$115.20 |
| Rate for Payer: Adventist Health Commercial |
$52.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.17
|
| Rate for Payer: Blue Shield of California Commercial |
$98.94
|
| Rate for Payer: Blue Shield of California EPN |
$64.51
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Cash Price |
$70.40
|
| Rate for Payer: Central Health Plan Commercial |
$102.40
|
| Rate for Payer: Cigna of CA HMO |
$89.60
|
| Rate for Payer: Cigna of CA PPO |
$89.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Senior |
$51.20
|
| Rate for Payer: Galaxy Health WC |
$108.80
|
| Rate for Payer: Global Benefits Group Commercial |
$76.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$115.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.45
|
| Rate for Payer: InnovAge PACE Commercial |
$64.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$85.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$79.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$89.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$89.60
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$64.00
|
| Rate for Payer: Prime Health Services Commercial |
$108.80
|
| Rate for Payer: Riverside University Health System MISP |
$51.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$76.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$76.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.04
|
| Rate for Payer: United Healthcare All Other HMO |
$46.76
|
| Rate for Payer: United Healthcare HMO Rider |
$45.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$108.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC PROSTATE BIOPSIES
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$850.50 |
| Rate for Payer: Adventist Health Commercial |
$189.00
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Central Health Plan Commercial |
$756.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: EPIC Health Plan Senior |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$360.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$584.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.00
|
| Rate for Payer: Multiplan Commercial |
$708.75
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC PROSTATE BIOPSIES
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$1,678.54 |
| Rate for Payer: Adventist Health Commercial |
$189.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$457.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$573.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,678.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.66
|
| Rate for Payer: Blue Shield of California Commercial |
$573.62
|
| Rate for Payer: Blue Shield of California EPN |
$375.17
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Cash Price |
$519.75
|
| Rate for Payer: Central Health Plan Commercial |
$756.00
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$850.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$588.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: InnovAge PACE Commercial |
$685.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$630.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$612.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$708.75
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$457.06
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Prime Health Services Medicare |
$484.48
|
| Rate for Payer: Riverside University Health System MISP |
$502.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC PROSTATE BIOPSY
|
Facility
|
OP
|
$6,411.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
909000175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$150.48 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,282.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,602.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,526.05
|
| Rate for Payer: Cash Price |
$3,526.05
|
| Rate for Payer: Cash Price |
$3,526.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,128.80
|
| Rate for Payer: Cigna of CA HMO |
$4,103.04
|
| Rate for Payer: Cigna of CA PPO |
$4,744.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$5,449.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,846.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,769.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$4,808.25
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,167.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$5,449.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,846.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC PROSTATE BIOPSY
|
Facility
|
IP
|
$6,411.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
909000175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,282.20 |
| Max. Negotiated Rate |
$5,769.90 |
| Rate for Payer: Adventist Health Commercial |
$1,282.20
|
| Rate for Payer: Cash Price |
$3,526.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,564.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,564.40
|
| Rate for Payer: Galaxy Health WC |
$5,449.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,846.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,769.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,442.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,968.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,282.20
|
| Rate for Payer: Multiplan Commercial |
$4,808.25
|
| Rate for Payer: Networks By Design Commercial |
$4,167.15
|
| Rate for Payer: Prime Health Services Commercial |
$5,449.35
|
|
|
HC PROSTATE CANCER SCREEN (PSA)
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900912101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$133.81 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.16
|
| Rate for Payer: Blue Shield of California Commercial |
$38.85
|
| Rate for Payer: Blue Shield of California EPN |
$25.41
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.39
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Riverside University Health System MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC PROSTATE CANCER SCREEN (PSA)
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900912101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Adventist Health Commercial |
$12.80
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Senior |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC PROSTATE SPECIFIC AG. FREE
|
Facility
|
OP
|
$102.70
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900912133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$133.22 |
| Rate for Payer: Adventist Health Commercial |
$20.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.04
|
| Rate for Payer: Blue Shield of California Commercial |
$62.34
|
| Rate for Payer: Blue Shield of California EPN |
$40.77
|
| Rate for Payer: Cash Price |
$56.49
|
| Rate for Payer: Cash Price |
$56.49
|
| Rate for Payer: Central Health Plan Commercial |
$82.16
|
| Rate for Payer: Cigna of CA HMO |
$65.73
|
| Rate for Payer: Cigna of CA PPO |
$76.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$87.30
|
| Rate for Payer: Global Benefits Group Commercial |
$61.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$77.03
|
| Rate for Payer: Networks By Design Commercial |
$66.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.39
|
| Rate for Payer: Prime Health Services Commercial |
$87.30
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Riverside University Health System MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC PROSTATE SPECIFIC AG. FREE
|
Facility
|
IP
|
$102.70
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900912133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$92.43 |
| Rate for Payer: Adventist Health Commercial |
$20.54
|
| Rate for Payer: Cash Price |
$56.49
|
| Rate for Payer: Central Health Plan Commercial |
$82.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.08
|
| Rate for Payer: EPIC Health Plan Senior |
$41.08
|
| Rate for Payer: Galaxy Health WC |
$87.30
|
| Rate for Payer: Global Benefits Group Commercial |
$61.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$77.03
|
| Rate for Payer: Networks By Design Commercial |
$66.75
|
| Rate for Payer: Prime Health Services Commercial |
$87.30
|
|
|
HC PROSTATE SPECIFIC ANTIGEN
|
Facility
|
IP
|
$102.70
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900910879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$92.43 |
| Rate for Payer: Adventist Health Commercial |
$20.54
|
| Rate for Payer: Cash Price |
$56.49
|
| Rate for Payer: Central Health Plan Commercial |
$82.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.08
|
| Rate for Payer: EPIC Health Plan Senior |
$41.08
|
| Rate for Payer: Galaxy Health WC |
$87.30
|
| Rate for Payer: Global Benefits Group Commercial |
$61.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$63.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$77.03
|
| Rate for Payer: Networks By Design Commercial |
$66.75
|
| Rate for Payer: Prime Health Services Commercial |
$87.30
|
|
|
HC PROSTATE SPECIFIC ANTIGEN
|
Facility
|
OP
|
$102.70
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900910879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$133.81 |
| Rate for Payer: Adventist Health Commercial |
$20.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.16
|
| Rate for Payer: Blue Shield of California Commercial |
$62.34
|
| Rate for Payer: Blue Shield of California EPN |
$40.77
|
| Rate for Payer: Cash Price |
$56.49
|
| Rate for Payer: Cash Price |
$56.49
|
| Rate for Payer: Central Health Plan Commercial |
$82.16
|
| Rate for Payer: Cigna of CA HMO |
$65.73
|
| Rate for Payer: Cigna of CA PPO |
$76.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$87.30
|
| Rate for Payer: Global Benefits Group Commercial |
$61.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$77.03
|
| Rate for Payer: Networks By Design Commercial |
$66.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.39
|
| Rate for Payer: Prime Health Services Commercial |
$87.30
|
| Rate for Payer: Prime Health Services Medicare |
$19.49
|
| Rate for Payer: Riverside University Health System MISP |
$20.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.89
|
| Rate for Payer: United Healthcare All Other HMO |
$14.89
|
| Rate for Payer: United Healthcare HMO Rider |
$14.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC PROSTH ADD SHOULDER HAMESS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L5699
|
| Hospital Charge Code |
915355699
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.62 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$143.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$248.83
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$274.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$175.00
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC PROSTH ADD SHOULDER HAMESS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L5699
|
| Hospital Charge Code |
915355699
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
|
HC PROSTH ADD SHOULDER HAMESS
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT L5699
|
| Hospital Charge Code |
905355699
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Blue Shield of California Commercial |
$270.55
|
| Rate for Payer: Blue Shield of California EPN |
$176.40
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$245.00
|
| Rate for Payer: Cigna of CA PPO |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$131.35
|
| Rate for Payer: United Healthcare All Other HMO |
$127.86
|
| Rate for Payer: United Healthcare HMO Rider |
$125.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.62
|
|
