|
HC RESUSCITATOR PEDS SPUR II
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698465
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC RETICULOCYTE COUNT, AUTO
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 85046
|
| Hospital Charge Code |
900910088
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$49.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.35
|
| Rate for Payer: Blue Distinction Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.98
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Caremore Medicare Advantage |
$5.57
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.36
|
| Rate for Payer: Dignity Health Media |
$5.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.52
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.57
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.57
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.57
|
| Rate for Payer: InnovAge PACE Commercial |
$8.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Prime Health Services Medicare |
$5.90
|
| Rate for Payer: Riverside University Health System MISP |
$6.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.51
|
| Rate for Payer: United Healthcare All Other HMO |
$4.51
|
| Rate for Payer: United Healthcare HMO Rider |
$4.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.13
|
| Rate for Payer: Vantage Medical Group Senior |
$5.57
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.20
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
|
|
HC RETICULOCYTE COUNT, MANUAL
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 85044
|
| Hospital Charge Code |
900910063
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$38.17 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.17
|
| Rate for Payer: Blue Distinction Transplant |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$14.83
|
| Rate for Payer: Blue Shield of California EPN |
$11.66
|
| Rate for Payer: Caremore Medicare Advantage |
$4.31
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.46
|
| Rate for Payer: Dignity Health Media |
$4.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.31
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.31
|
| Rate for Payer: InnovAge PACE Commercial |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Prime Health Services Medicare |
$4.57
|
| Rate for Payer: Riverside University Health System MISP |
$4.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.49
|
| Rate for Payer: United Healthcare All Other HMO |
$3.49
|
| Rate for Payer: United Healthcare HMO Rider |
$3.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Vantage Medical Group Senior |
$4.31
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
OP
|
$7,599.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$499.40 |
| Max. Negotiated Rate |
$11,071.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$726.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,071.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$726.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,559.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$726.26
|
| Rate for Payer: Cash Price |
$3,419.55
|
| Rate for Payer: Cash Price |
$3,419.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,079.20
|
| Rate for Payer: Cigna of CA PPO |
$5,623.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Dignity Health Media |
$726.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$798.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$726.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$726.26
|
| Rate for Payer: Galaxy Health WC |
$6,459.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,559.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,839.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,699.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,191.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,198.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$726.26
|
| Rate for Payer: InnovAge PACE Commercial |
$1,089.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,519.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$973.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$973.19
|
| Rate for Payer: Multiplan Commercial |
$5,699.25
|
| Rate for Payer: Networks By Design Commercial |
$4,939.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,459.15
|
| Rate for Payer: Prime Health Services Medicare |
$769.84
|
| Rate for Payer: Riverside University Health System MISP |
$798.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,559.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,089.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$798.89
|
| Rate for Payer: Vantage Medical Group Senior |
$726.26
|
|
|
HC RETINAL REPAIR LASER, PHOTOCOAG
|
Facility
|
IP
|
$7,599.00
|
|
|
Service Code
|
CPT 67105
|
| Hospital Charge Code |
988167105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,519.80 |
| Max. Negotiated Rate |
$6,839.10 |
| Rate for Payer: Cash Price |
$3,419.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,079.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,039.60
|
| Rate for Payer: Galaxy Health WC |
$6,459.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,559.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,839.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,068.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,895.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,519.80
|
| Rate for Payer: Multiplan Commercial |
$5,699.25
|
| Rate for Payer: Networks By Design Commercial |
$4,939.35
|
| Rate for Payer: Prime Health Services Commercial |
$6,459.15
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$550.20
|
| Rate for Payer: Caremore Medicare Advantage |
$363.98
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$678.58
|
| 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 |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$687.75
|
| 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 |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| 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 |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| 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 |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$458.50
|
| Rate for Payer: United Healthcare All Other HMO |
$458.50
|
| Rate for Payer: United Healthcare HMO Rider |
$458.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.50
|
| 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 RETROBULBAR INJECTION
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$825.30 |
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$366.80
|
| Rate for Payer: Galaxy Health WC |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$349.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
|
|
HC RETROBULBAR INJECTION
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$363.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$365.50
|
| 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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$550.20
|
| Rate for Payer: Blue Shield of California Commercial |
$576.79
|
| Rate for Payer: Blue Shield of California EPN |
$448.41
|
| Rate for Payer: Caremore Medicare Advantage |
$363.98
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA HMO |
$586.88
|
| Rate for Payer: Cigna of CA PPO |
$678.58
|
| 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 |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$687.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$600.57
|
| 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 |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| 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 |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| 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 |
$550.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$458.50
|
| Rate for Payer: United Healthcare All Other HMO |
$458.50
|
| Rate for Payer: United Healthcare HMO Rider |
$458.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$458.50
|
| 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 RETROBULBAR INJECTION
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 67500
|
| Hospital Charge Code |
900567500
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$183.40 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$363.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$365.50
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$550.20
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Caremore Medicare Advantage |
$363.98
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Cash Price |
$412.65
|
| Rate for Payer: Central Health Plan Commercial |
$733.60
|
| Rate for Payer: Cigna of CA PPO |
$678.58
|
| 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 |
$779.45
|
| Rate for Payer: Global Benefits Group Commercial |
$550.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$825.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$687.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$596.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$600.57
|
| 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 |
$611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$363.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.40
|
| 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 |
$687.75
|
| Rate for Payer: Networks By Design Commercial |
$596.05
|
| Rate for Payer: Prime Health Services Commercial |
$779.45
|
| 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 |
$550.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$545.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.38
|
| Rate for Payer: Vantage Medical Group Senior |
$363.98
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
IP
|
$6,999.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,399.80 |
| Max. Negotiated Rate |
$6,299.10 |
| Rate for Payer: Cash Price |
$3,149.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,799.60
|
| Rate for Payer: Galaxy Health WC |
$5,949.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,199.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,666.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,399.80
|
| Rate for Payer: Multiplan Commercial |
$5,249.25
|
| Rate for Payer: Networks By Design Commercial |
$4,549.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,949.15
|
|
|
HC RETROGRADE DBL BLLN ENTSCPY
|
Facility
|
OP
|
$6,999.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745435
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,388.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,135.01
|
| Rate for Payer: Blue Distinction Transplant |
$4,199.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$3,149.55
|
| Rate for Payer: Cash Price |
$3,149.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,599.20
|
| Rate for Payer: Cigna of CA PPO |
$5,179.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$5,949.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,199.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,299.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,249.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,668.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,399.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$5,249.25
|
| Rate for Payer: Networks By Design Commercial |
$4,549.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,949.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,199.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| 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 |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
OP
|
$6,999.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,132.59 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,388.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,135.01
|
| Rate for Payer: Blue Distinction Transplant |
$4,199.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$3,149.55
|
| Rate for Payer: Cash Price |
$3,149.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,599.20
|
| Rate for Payer: Cigna of CA PPO |
$5,179.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Dignity Health Media |
$1,132.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,245.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$5,949.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,199.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,299.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,249.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,868.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,132.59
|
| Rate for Payer: InnovAge PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,668.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,399.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$5,249.25
|
| Rate for Payer: Networks By Design Commercial |
$4,549.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,949.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,199.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| 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 |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
HC RETROGRADE SNGL BLLN ENTSCPY
|
Facility
|
IP
|
$6,999.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
906745434
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,399.80 |
| Max. Negotiated Rate |
$6,299.10 |
| Rate for Payer: Cash Price |
$3,149.55
|
| Rate for Payer: Central Health Plan Commercial |
$5,599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,799.60
|
| Rate for Payer: Galaxy Health WC |
$5,949.15
|
| Rate for Payer: Global Benefits Group Commercial |
$4,199.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,299.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,668.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,666.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,399.80
|
| Rate for Payer: Multiplan Commercial |
$5,249.25
|
| Rate for Payer: Networks By Design Commercial |
$4,549.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,949.15
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$988.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$988.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$302.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.89
|
| Rate for Payer: Blue Distinction Transplant |
$655.80
|
| Rate for Payer: Blue Shield of California Commercial |
$675.47
|
| Rate for Payer: Blue Shield of California EPN |
$531.20
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: Cigna of CA HMO |
$699.52
|
| Rate for Payer: Cigna of CA PPO |
$808.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$819.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$655.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$655.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC RETROGRAD URETHROGRAM
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.60 |
| Max. Negotiated Rate |
$983.70 |
| Rate for Payer: Cash Price |
$491.85
|
| Rate for Payer: Central Health Plan Commercial |
$874.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$437.20
|
| Rate for Payer: Galaxy Health WC |
$929.05
|
| Rate for Payer: Global Benefits Group Commercial |
$655.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$983.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$729.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$416.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.60
|
| Rate for Payer: Multiplan Commercial |
$819.75
|
| Rate for Payer: Networks By Design Commercial |
$710.45
|
| Rate for Payer: Prime Health Services Commercial |
$929.05
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
IP
|
$924.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.80 |
| Max. Negotiated Rate |
$831.60 |
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$369.60
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
OP
|
$924.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.20 |
| Max. Negotiated Rate |
$988.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$480.50
|
| Rate for Payer: Aetna of CA HMO/PPO |
$988.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$480.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$478.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$584.20
|
| Rate for Payer: Blue Distinction Transplant |
$554.40
|
| Rate for Payer: Blue Shield of California Commercial |
$571.03
|
| Rate for Payer: Blue Shield of California EPN |
$449.06
|
| Rate for Payer: Caremore Medicare Advantage |
$480.50
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Cash Price |
$415.80
|
| Rate for Payer: Central Health Plan Commercial |
$739.20
|
| Rate for Payer: Cigna of CA HMO |
$591.36
|
| Rate for Payer: Cigna of CA PPO |
$683.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$720.75
|
| Rate for Payer: Dignity Health Media |
$480.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$528.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$480.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$480.50
|
| Rate for Payer: Galaxy Health WC |
$785.40
|
| Rate for Payer: Global Benefits Group Commercial |
$554.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$831.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$693.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$788.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$792.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$480.50
|
| Rate for Payer: InnovAge PACE Commercial |
$720.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$643.87
|
| Rate for Payer: Multiplan Commercial |
$693.00
|
| Rate for Payer: Networks By Design Commercial |
$600.60
|
| Rate for Payer: Prime Health Services Commercial |
$785.40
|
| Rate for Payer: Prime Health Services Medicare |
$509.33
|
| Rate for Payer: Riverside University Health System MISP |
$528.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$554.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$720.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$528.55
|
| Rate for Payer: Vantage Medical Group Senior |
$480.50
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.30 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$168.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.98
|
| Rate for Payer: Blue Distinction Transplant |
$118.80
|
| Rate for Payer: Blue Shield of California Commercial |
$148.50
|
| Rate for Payer: Blue Shield of California EPN |
$107.71
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$168.30
|
| Rate for Payer: Dignity Health Media |
$168.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$168.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$148.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.18
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$99.00
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: Riverside University Health System MISP |
$79.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.00
|
| Rate for Payer: United Healthcare All Other HMO |
$99.00
|
| Rate for Payer: United Healthcare HMO Rider |
$99.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$99.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$168.30
|
| Rate for Payer: Vantage Medical Group Senior |
$168.30
|
|
|
HC REVERSE KNUCKLE BENDER
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
901309138
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$178.20 |
| Rate for Payer: Blue Shield of California EPN |
$105.73
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Central Health Plan Commercial |
$158.40
|
| Rate for Payer: Cigna of CA HMO |
$138.60
|
| Rate for Payer: Cigna of CA PPO |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$178.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.60
|
| Rate for Payer: Multiplan Commercial |
$148.50
|
| Rate for Payer: Networks By Design Commercial |
$99.00
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.76
|
| Rate for Payer: United Healthcare All Other HMO |
$73.02
|
| Rate for Payer: United Healthcare HMO Rider |
$71.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.34
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$35,850.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,170.00 |
| Max. Negotiated Rate |
$32,265.00 |
| Rate for Payer: Cash Price |
$16,132.50
|
| Rate for Payer: Central Health Plan Commercial |
$28,680.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,340.00
|
| Rate for Payer: Galaxy Health WC |
$30,472.50
|
| Rate for Payer: Global Benefits Group Commercial |
$21,510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,265.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,911.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,658.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,170.00
|
| Rate for Payer: Multiplan Commercial |
$26,887.50
|
| Rate for Payer: Networks By Design Commercial |
$23,302.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,472.50
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$35,850.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$474.73 |
| Max. Negotiated Rate |
$48,045.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,141.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26,109.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,141.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$21,510.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$7,141.35
|
| Rate for Payer: Cash Price |
$16,132.50
|
| Rate for Payer: Cash Price |
$16,132.50
|
| Rate for Payer: Central Health Plan Commercial |
$28,680.00
|
| Rate for Payer: Cigna of CA PPO |
$26,529.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Dignity Health Media |
$7,141.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,855.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,640.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,141.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,141.35
|
| Rate for Payer: Galaxy Health WC |
$30,472.50
|
| Rate for Payer: Global Benefits Group Commercial |
$21,510.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,265.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$26,887.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,711.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,783.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,141.35
|
| Rate for Payer: InnovAge PACE Commercial |
$10,712.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,911.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,141.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,170.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,569.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,569.41
|
| Rate for Payer: Multiplan Commercial |
$26,887.50
|
| Rate for Payer: Networks By Design Commercial |
$23,302.50
|
| Rate for Payer: Prime Health Services Commercial |
$30,472.50
|
| Rate for Payer: Prime Health Services Medicare |
$7,569.83
|
| Rate for Payer: Riverside University Health System MISP |
$7,855.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,510.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$29,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$48,045.00
|
| Rate for Payer: United Healthcare HMO Rider |
$31,101.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,895.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,712.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,855.48
|
| Rate for Payer: Vantage Medical Group Senior |
$7,141.35
|
|
