|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$605.40
|
| Rate for Payer: Caremore Medicare Advantage |
$363.98
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Central Health Plan Commercial |
$807.20
|
| Rate for Payer: Cigna of CA PPO |
$746.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$545.97
|
| Rate for Payer: Dignity Health Media |
$363.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$363.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$363.98
|
| Rate for Payer: Galaxy Health WC |
$857.65
|
| Rate for Payer: Global Benefits Group Commercial |
$605.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$908.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$756.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$363.98
|
| Rate for Payer: InnovAge PACE Commercial |
$545.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$487.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$487.73
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
| Rate for Payer: Networks By Design Commercial |
$655.85
|
| Rate for Payer: Prime Health Services Commercial |
$857.65
|
| Rate for Payer: Prime Health Services Medicare |
$385.82
|
| Rate for Payer: Riverside University Health System MISP |
$400.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$605.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.50
|
| Rate for Payer: United Healthcare All Other HMO |
$504.50
|
| Rate for Payer: United Healthcare HMO Rider |
$504.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$504.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$908.10 |
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Central Health Plan Commercial |
$807.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.60
|
| Rate for Payer: Galaxy Health WC |
$857.65
|
| Rate for Payer: Global Benefits Group Commercial |
$605.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$908.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$384.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
| Rate for Payer: Networks By Design Commercial |
$655.85
|
| Rate for Payer: Prime Health Services Commercial |
$857.65
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
IP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
905355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$406.80 |
| Max. Negotiated Rate |
$1,830.60 |
| Rate for Payer: Blue Shield of California EPN |
$1,086.16
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,627.20
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,830.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$774.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$406.80
|
| Rate for Payer: Multiplan Commercial |
$1,525.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.04
|
| Rate for Payer: United Healthcare All Other HMO |
$750.14
|
| Rate for Payer: United Healthcare HMO Rider |
$733.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$671.22
|
|
|
HC PROS ADD ENDO EXIAL ROTAT UNIT
|
Facility
|
OP
|
$2,034.00
|
|
|
Service Code
|
CPT L5984
|
| Hospital Charge Code |
905355984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$642.30 |
| Max. Negotiated Rate |
$1,830.60 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,118.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,118.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$984.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,201.69
|
| Rate for Payer: Blue Distinction Transplant |
$1,220.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,525.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,106.50
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Cash Price |
$915.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,627.20
|
| Rate for Payer: Cigna of CA HMO |
$1,423.80
|
| Rate for Payer: Cigna of CA PPO |
$1,423.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,728.90
|
| Rate for Payer: Dignity Health Media |
$1,728.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,728.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.60
|
| Rate for Payer: Galaxy Health WC |
$1,728.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,220.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,830.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,525.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$711.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,356.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$642.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.94
|
| Rate for Payer: Multiplan Commercial |
$1,525.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.90
|
| Rate for Payer: Riverside University Health System MISP |
$813.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,220.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,220.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,017.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,017.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,017.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,017.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,728.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,728.90
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
905355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$1,217.70 |
| Rate for Payer: Blue Shield of California EPN |
$722.50
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,082.40
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,217.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$515.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.60
|
| Rate for Payer: Multiplan Commercial |
$1,014.75
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$510.89
|
| Rate for Payer: United Healthcare All Other HMO |
$498.99
|
| Rate for Payer: United Healthcare HMO Rider |
$488.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$446.49
|
|
|
HC PROS ADD EXO AXIAL ROTAT UNIT
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT L5982
|
| Hospital Charge Code |
905355982
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$473.55 |
| Max. Negotiated Rate |
$1,217.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$744.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$744.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$655.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$799.35
|
| Rate for Payer: Blue Distinction Transplant |
$811.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,014.75
|
| Rate for Payer: Blue Shield of California EPN |
$736.03
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Cash Price |
$608.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,082.40
|
| Rate for Payer: Cigna of CA HMO |
$947.10
|
| Rate for Payer: Cigna of CA PPO |
$947.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,150.05
|
| Rate for Payer: Dignity Health Media |
$1,150.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,150.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$541.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$541.20
|
| Rate for Payer: Galaxy Health WC |
$1,150.05
|
| Rate for Payer: Global Benefits Group Commercial |
$811.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,217.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,014.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$473.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$554.73
|
| Rate for Payer: Multiplan Commercial |
$1,014.75
|
| Rate for Payer: Networks By Design Commercial |
$676.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,150.05
|
| Rate for Payer: Riverside University Health System MISP |
$541.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$811.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$811.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.50
|
| Rate for Payer: United Healthcare All Other HMO |
$676.50
|
| Rate for Payer: United Healthcare HMO Rider |
$676.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,150.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,150.05
|
|
|
HC PROS ADDIT MCP ROTATION UNIT
|
Facility
|
OP
|
$2,316.00
|
|
|
Service Code
|
CPT L5986
|
| Hospital Charge Code |
905355986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$714.46 |
| Max. Negotiated Rate |
$2,084.40 |
| 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 |
$1,273.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,121.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,368.29
|
| Rate for Payer: Blue Distinction Transplant |
$1,389.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,737.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,259.90
|
| Rate for Payer: Cash Price |
$1,042.20
|
| Rate for Payer: Cash Price |
$1,042.20
|
| 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 Media |
$1,968.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,968.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,737.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$810.60
|
| 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: LLUH Dept of Risk Management WC |
$949.56
|
| 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 |
$1,158.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,158.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,158.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,158.00
|
| 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: Blue Shield of California EPN |
$1,236.74
|
| Rate for Payer: Cash Price |
$1,042.20
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$463.20
|
| 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: United Healthcare All Other Commercial |
$874.52
|
| Rate for Payer: United Healthcare All Other HMO |
$854.14
|
| Rate for Payer: United Healthcare HMO Rider |
$835.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$764.28
|
|
|
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: Blue Shield of California EPN |
$68.35
|
| Rate for Payer: Cash Price |
$57.60
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$25.60
|
| 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: United Healthcare All Other Commercial |
$48.33
|
| Rate for Payer: United Healthcare All Other HMO |
$47.21
|
| Rate for Payer: United Healthcare HMO Rider |
$46.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.24
|
|
|
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 |
$44.80 |
| Max. Negotiated Rate |
$115.20 |
| 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 |
$70.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.62
|
| Rate for Payer: Blue Distinction Transplant |
$76.80
|
| Rate for Payer: Blue Shield of California Commercial |
$96.00
|
| Rate for Payer: Blue Shield of California EPN |
$69.63
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| 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 Media |
$108.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$108.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$96.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.80
|
| 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: LLUH Dept of Risk Management WC |
$52.48
|
| 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 |
$64.00
|
| Rate for Payer: United Healthcare All Other HMO |
$64.00
|
| Rate for Payer: United Healthcare HMO Rider |
$64.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$108.80
|
| Rate for Payer: Vantage Medical Group Senior |
$108.80
|
|
|
HC PROSTATE BIOPSIES 10-20 SPEC
|
Facility
|
OP
|
$12,253.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$240.94 |
| Max. Negotiated Rate |
$11,027.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$449.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,238.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,678.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,047.41
|
| Rate for Payer: Blue Distinction Transplant |
$7,351.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,572.35
|
| Rate for Payer: Blue Shield of California EPN |
$5,954.96
|
| Rate for Payer: Caremore Medicare Advantage |
$449.11
|
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,802.40
|
| Rate for Payer: Cigna of CA HMO |
$7,841.92
|
| Rate for Payer: Cigna of CA PPO |
$9,067.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Media |
$449.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| Rate for Payer: Galaxy Health WC |
$10,415.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,351.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,027.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,189.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$736.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$741.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: InnovAge PACE Commercial |
$673.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,450.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| Rate for Payer: Multiplan Commercial |
$9,189.75
|
| Rate for Payer: Networks By Design Commercial |
$7,964.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,415.05
|
| Rate for Payer: Prime Health Services Medicare |
$476.06
|
| Rate for Payer: Riverside University Health System MISP |
$494.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,351.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,351.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC PROSTATE BIOPSIES 10-20 SPEC
|
Facility
|
IP
|
$12,253.00
|
|
|
Service Code
|
CPT G0416
|
| Hospital Charge Code |
903800232
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$2,450.60 |
| Max. Negotiated Rate |
$11,027.70 |
| Rate for Payer: Cash Price |
$5,513.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,802.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,901.20
|
| Rate for Payer: Galaxy Health WC |
$10,415.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,351.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,027.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,668.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,450.60
|
| Rate for Payer: Multiplan Commercial |
$9,189.75
|
| Rate for Payer: Networks By Design Commercial |
$7,964.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,415.05
|
|
|
HC PROSTATE BIOPSY
|
Facility
|
OP
|
$4,848.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
909000175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$166.23 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,544.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,544.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,908.80
|
| 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 |
$2,544.87
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,878.40
|
| Rate for Payer: Cigna of CA PPO |
$3,587.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Dignity Health Media |
$2,544.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,799.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,544.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,544.87
|
| Rate for Payer: Galaxy Health WC |
$4,120.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,908.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,363.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,636.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,173.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,199.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,544.87
|
| Rate for Payer: InnovAge PACE Commercial |
$3,817.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,233.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,544.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,410.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,410.13
|
| Rate for Payer: Multiplan Commercial |
$3,636.00
|
| Rate for Payer: Networks By Design Commercial |
$3,151.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,120.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,697.56
|
| Rate for Payer: Riverside University Health System MISP |
$2,799.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,908.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,817.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,799.36
|
| Rate for Payer: Vantage Medical Group Senior |
$2,544.87
|
|
|
HC PROSTATE BIOPSY
|
Facility
|
IP
|
$4,848.00
|
|
|
Service Code
|
CPT 55700
|
| Hospital Charge Code |
909000175
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$969.60 |
| Max. Negotiated Rate |
$4,363.20 |
| Rate for Payer: Cash Price |
$2,181.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,878.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,939.20
|
| Rate for Payer: Galaxy Health WC |
$4,120.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,908.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,363.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,233.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,847.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$969.60
|
| Rate for Payer: Multiplan Commercial |
$3,636.00
|
| Rate for Payer: Networks By Design Commercial |
$3,151.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,120.80
|
|
|
HC PROSTATE CANCER SCREEN (PSA)
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900912101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$190.80 |
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Central Health Plan Commercial |
$169.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$190.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$159.00
|
| Rate for Payer: Networks By Design Commercial |
$137.80
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
|
|
HC PROSTATE CANCER SCREEN (PSA)
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900912101
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.58
|
| 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 |
$163.21
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: Dignity Health Media |
$18.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| 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 |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| 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 |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| 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
|
$244.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900912133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC PROSTATE SPECIFIC AG. FREE
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
900912133
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$162.49 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.58
|
| 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 |
$162.49
|
| Rate for Payer: Blue Distinction Transplant |
$34.20
|
| Rate for Payer: Blue Shield of California Commercial |
$35.23
|
| Rate for Payer: Blue Shield of California EPN |
$27.70
|
| Rate for Payer: Caremore Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: Dignity Health Media |
$18.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.02
|
| 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 |
$11.40
|
| 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 |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| 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 |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC PROSTATE SPECIFIC ANTIGEN
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900910879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$163.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$18.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.58
|
| 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 |
$163.21
|
| Rate for Payer: Blue Distinction Transplant |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.60
|
| Rate for Payer: Blue Shield of California EPN |
$10.69
|
| Rate for Payer: Caremore Medicare Advantage |
$18.39
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Central Health Plan Commercial |
$17.60
|
| Rate for Payer: Cigna of CA HMO |
$14.08
|
| Rate for Payer: Cigna of CA PPO |
$16.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.58
|
| Rate for Payer: Dignity Health Media |
$18.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$18.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.39
|
| Rate for Payer: Galaxy Health WC |
$18.70
|
| Rate for Payer: Global Benefits Group Commercial |
$13.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$30.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.39
|
| Rate for Payer: InnovAge PACE Commercial |
$27.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.40
|
| 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 |
$16.50
|
| Rate for Payer: Networks By Design Commercial |
$14.30
|
| Rate for Payer: Prime Health Services Commercial |
$18.70
|
| 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 |
$13.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.90
|
| Rate for Payer: United Healthcare All Other HMO |
$14.90
|
| Rate for Payer: United Healthcare HMO Rider |
$14.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.23
|
| Rate for Payer: Vantage Medical Group Senior |
$18.39
|
|
|
HC PROSTATE SPECIFIC ANTIGEN
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
900910879
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC 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: Blue Shield of California EPN |
$186.90
|
| Rate for Payer: Cash Price |
$157.50
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$70.00
|
| 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: United Healthcare All Other Commercial |
$132.16
|
| Rate for Payer: United Healthcare All Other HMO |
$129.08
|
| Rate for Payer: United Healthcare HMO Rider |
$126.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.50
|
|
|
HC PROSTH ADD SHOULDER HAMESS
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT L5699
|
| Hospital Charge Code |
905355699
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$315.00 |
| 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 |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: Blue Distinction Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$262.50
|
| Rate for Payer: Blue Shield of California EPN |
$190.40
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| 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 Media |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$262.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$122.50
|
| 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: LLUH Dept of Risk Management WC |
$143.50
|
| 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 |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC PROSTHETIC SHEATH AK EACH
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT L8410
|
| Hospital Charge Code |
905358410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.08
|
| Rate for Payer: Blue Distinction Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$75.00
|
| Rate for Payer: Blue Shield of California EPN |
$54.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Media |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50.00
|
| Rate for Payer: United Healthcare HMO Rider |
$50.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC PROSTHETIC SHEATH AK EACH
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT L8410
|
| Hospital Charge Code |
905358410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Blue Shield of California EPN |
$53.40
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$70.00
|
| Rate for Payer: Cigna of CA PPO |
$70.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$50.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.76
|
| Rate for Payer: United Healthcare All Other HMO |
$36.88
|
| Rate for Payer: United Healthcare HMO Rider |
$36.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.00
|
|
|
HC PROSTHETIC SHEATH BK EACH
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT L8400
|
| Hospital Charge Code |
905358400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.57 |
| Max. Negotiated Rate |
$81.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$49.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$43.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.17
|
| Rate for Payer: Blue Distinction Transplant |
$54.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.50
|
| Rate for Payer: Blue Shield of California EPN |
$48.96
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Central Health Plan Commercial |
$72.00
|
| Rate for Payer: Cigna of CA HMO |
$63.00
|
| Rate for Payer: Cigna of CA PPO |
$63.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.50
|
| Rate for Payer: Dignity Health Media |
$76.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$76.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.00
|
| Rate for Payer: Galaxy Health WC |
$76.50
|
| Rate for Payer: Global Benefits Group Commercial |
$54.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$67.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.90
|
| Rate for Payer: Multiplan Commercial |
$67.50
|
| Rate for Payer: Networks By Design Commercial |
$45.00
|
| Rate for Payer: Prime Health Services Commercial |
$76.50
|
| Rate for Payer: Riverside University Health System MISP |
$36.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.00
|
| Rate for Payer: United Healthcare All Other HMO |
$45.00
|
| Rate for Payer: United Healthcare HMO Rider |
$45.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$76.50
|
| Rate for Payer: Vantage Medical Group Senior |
$76.50
|
|
