|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
IP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$193.85 |
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Central Health Plan Commercial |
$172.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.08
|
| Rate for Payer: Multiplan Commercial |
$161.54
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
|
|
HC SHTH PERCUTANEOUS INTRO 8.5FR
|
Facility
OP
|
$350.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare 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: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| 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 |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health 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 SHTH PERCUTANEOUS INTRO 8.5FR
|
Facility
IP
|
$350.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC SHTH PER-Q 8.5FR X 10CM BRK
|
Facility
IP
|
$279.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Cash Price |
$125.69
|
| Rate for Payer: Central Health Plan Commercial |
$223.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.72
|
| Rate for Payer: Galaxy Health WC |
$237.40
|
| Rate for Payer: Global Benefits Group Commercial |
$167.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$251.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.86
|
| Rate for Payer: Multiplan Commercial |
$209.48
|
| Rate for Payer: Networks By Design Commercial |
$181.54
|
| Rate for Payer: Prime Health Services Commercial |
$237.40
|
|
|
HC SHTH PER-Q 8.5FR X 10CM BRK
|
Facility
OP
|
$279.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$237.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$153.62
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$153.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.01
|
| Rate for Payer: BCBS Transplant Transplant |
$167.58
|
| Rate for Payer: Blue Shield of California Commercial |
$175.68
|
| Rate for Payer: Blue Shield of California EPN |
$136.58
|
| Rate for Payer: Cash Price |
$125.69
|
| Rate for Payer: Cash Price |
$125.69
|
| Rate for Payer: Central Health Plan Commercial |
$223.44
|
| Rate for Payer: Cigna of CA HMO |
$178.75
|
| Rate for Payer: Cigna of CA PPO |
$206.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$111.72
|
| Rate for Payer: Galaxy Health WC |
$237.40
|
| Rate for Payer: Global Benefits Group Commercial |
$167.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$251.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$209.48
|
| Rate for Payer: IEHP medi-cal |
$97.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.86
|
| Rate for Payer: Multiplan Commercial |
$209.48
|
| Rate for Payer: Networks By Design Commercial |
$181.54
|
| Rate for Payer: Prime Health Services Commercial |
$237.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$167.58
|
| Rate for Payer: Riverside University Health MISP |
$111.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$167.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$167.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.65
|
| Rate for Payer: United Healthcare All Other HMO |
$139.65
|
| Rate for Payer: United Healthcare HMO Rider |
$139.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.40
|
| Rate for Payer: Vantage Medical Group Senior |
$237.40
|
|
|
HC SHUNT EVALUATION
|
Facility
IP
|
$2,695.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$539.00 |
| Max. Negotiated Rate |
$2,425.50 |
| Rate for Payer: Cash Price |
$1,212.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,156.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,078.00
|
| Rate for Payer: Galaxy Health WC |
$2,290.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,617.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,425.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,797.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.00
|
| Rate for Payer: Multiplan Commercial |
$2,021.25
|
| Rate for Payer: Networks By Design Commercial |
$1,751.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,290.75
|
|
|
HC SHUNT EVALUATION
|
Facility
OP
|
$2,695.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$539.00 |
| Max. Negotiated Rate |
$2,425.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,349.61
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$708.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,592.21
|
| Rate for Payer: BCBS Transplant Transplant |
$1,617.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,665.51
|
| Rate for Payer: Blue Shield of California EPN |
$1,309.77
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$1,212.75
|
| Rate for Payer: Cash Price |
$1,212.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,156.00
|
| Rate for Payer: Cigna of CA HMO |
$1,724.80
|
| Rate for Payer: Cigna of CA PPO |
$1,994.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$2,290.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,617.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,425.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,021.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: IEHP medi-cal |
$1,114.29
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Innovage PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,797.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$539.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,021.25
|
| Rate for Payer: Networks By Design Commercial |
$1,751.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,290.75
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,617.00
|
| Rate for Payer: Riverside University Health MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,617.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,617.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC SHUNTOGRAM
|
Facility
IP
|
$827.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC SHUNTOGRAM
|
Facility
OP
|
$827.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$137.36 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$417.41
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.35
|
| Rate for Payer: BCBS Transplant Transplant |
$496.20
|
| Rate for Payer: Blue Shield of California Commercial |
$511.09
|
| Rate for Payer: Blue Shield of California EPN |
$401.92
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Cigna of CA HMO |
$529.28
|
| Rate for Payer: Cigna of CA PPO |
$611.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$620.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: IEHP medi-cal |
$226.64
|
| Rate for Payer: IEHP Medicare Advantage |
$137.36
|
| Rate for Payer: Innovage PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$496.20
|
| Rate for Payer: Riverside University Health MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC SHVG LSN TRNK ARM LEG LT 0.5CM
|
Facility
IP
|
$331.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
902809295
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Central Health Plan Commercial |
$264.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.20
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC SHVG LSN TRNK ARM LEG LT 0.5CM
|
Facility
OP
|
$331.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
902809295
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.23
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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: BCBS Transplant Transplant |
$198.60
|
| Rate for Payer: Blue Shield of California Commercial |
$208.20
|
| Rate for Payer: Blue Shield of California EPN |
$161.86
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Central Health Plan Commercial |
$264.80
|
| Rate for Payer: Cigna of CA HMO |
$211.84
|
| Rate for Payer: Cigna of CA PPO |
$244.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$248.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.50
|
| Rate for Payer: United Healthcare All Other HMO |
$165.50
|
| Rate for Payer: United Healthcare HMO Rider |
$165.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC SIALOGRAM
|
Facility
IP
|
$446.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Central Health Plan Commercial |
$356.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.40
|
| Rate for Payer: Galaxy Health WC |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$401.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$297.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.20
|
| Rate for Payer: Multiplan Commercial |
$334.50
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
|
|
HC SIALOGRAM
|
Facility
OP
|
$446.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$605.23 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$465.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$369.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.22
|
| Rate for Payer: BCBS Transplant Transplant |
$267.60
|
| Rate for Payer: Blue Shield of California Commercial |
$275.63
|
| Rate for Payer: Blue Shield of California EPN |
$216.76
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Central Health Plan Commercial |
$356.80
|
| Rate for Payer: Cigna of CA HMO |
$285.44
|
| Rate for Payer: Cigna of CA PPO |
$330.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| 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 |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$401.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$334.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: IEHP medi-cal |
$505.16
|
| Rate for Payer: IEHP Medicare Advantage |
$306.16
|
| Rate for Payer: Innovage PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$297.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.20
|
| 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 |
$334.50
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$267.60
|
| Rate for Payer: Riverside University Health MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| 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 SIALOGRAPHY DUCT DILATION
|
Facility
IP
|
$3,031.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$606.20 |
| Max. Negotiated Rate |
$2,727.90 |
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,424.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,212.40
|
| Rate for Payer: Galaxy Health WC |
$2,576.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,818.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,727.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,021.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.20
|
| Rate for Payer: Multiplan Commercial |
$2,273.25
|
| Rate for Payer: Networks By Design Commercial |
$1,970.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,576.35
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
OP
|
$3,031.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$606.20 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$687.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$1,818.60
|
| 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 |
$687.44
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,424.80
|
| Rate for Payer: Cigna of CA PPO |
$2,242.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$2,576.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,818.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,727.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,273.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: IEHP medi-cal |
$1,134.28
|
| Rate for Payer: IEHP Medicare Advantage |
$687.44
|
| Rate for Payer: Innovage PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,021.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$2,273.25
|
| Rate for Payer: Networks By Design Commercial |
$1,970.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,576.35
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,818.60
|
| Rate for Payer: Riverside University Health MISP |
$756.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,818.60
|
| 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 |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
IP
|
$455.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
OP
|
$455.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$386.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$250.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$273.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$386.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$341.25
|
| Rate for Payer: IEHP medi-cal |
$159.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$303.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$273.00
|
| Rate for Payer: Riverside University Health MISP |
$182.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.75
|
| Rate for Payer: Vantage Medical Group Senior |
$386.75
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
IP
|
$7,704.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,540.80 |
| Max. Negotiated Rate |
$6,933.60 |
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,933.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| 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: BCBS Transplant Transplant |
$4,622.40
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,778.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$4,022.69
|
| Rate for Payer: Innovage PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,622.40
|
| Rate for Payer: Riverside University Health MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
IP
|
$3,797.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906820024
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$759.40 |
| Max. Negotiated Rate |
$3,417.30 |
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,037.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,518.80
|
| Rate for Payer: Galaxy Health WC |
$3,227.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,278.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,417.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,532.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.40
|
| Rate for Payer: Multiplan Commercial |
$2,847.75
|
| Rate for Payer: Networks By Design Commercial |
$2,468.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,227.45
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
IP
|
$3,797.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906811490
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$759.40 |
| Max. Negotiated Rate |
$3,417.30 |
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,037.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,518.80
|
| Rate for Payer: Galaxy Health WC |
$3,227.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,278.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,417.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,532.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.40
|
| Rate for Payer: Multiplan Commercial |
$2,847.75
|
| Rate for Payer: Networks By Design Commercial |
$2,468.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,227.45
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906811490
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$651.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,227.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,088.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,088.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,278.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,037.60
|
| Rate for Payer: Cigna of CA HMO |
$2,430.08
|
| Rate for Payer: Cigna of CA PPO |
$2,809.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,227.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,518.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,518.80
|
| Rate for Payer: Galaxy Health WC |
$3,227.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,278.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,417.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,847.75
|
| Rate for Payer: IEHP medi-cal |
$1,328.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,532.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.40
|
| Rate for Payer: Multiplan Commercial |
$2,847.75
|
| Rate for Payer: Networks By Design Commercial |
$2,468.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,227.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,278.20
|
| Rate for Payer: Riverside University Health MISP |
$1,518.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,278.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,278.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,227.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,227.45
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
OP
|
$3,797.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906820024
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$651.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,227.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,088.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,088.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: BCBS Transplant Transplant |
$2,278.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Cash Price |
$1,708.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,037.60
|
| Rate for Payer: Cigna of CA HMO |
$2,430.08
|
| Rate for Payer: Cigna of CA PPO |
$2,809.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,227.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,518.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,518.80
|
| Rate for Payer: Galaxy Health WC |
$3,227.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,278.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,417.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,847.75
|
| Rate for Payer: IEHP medi-cal |
$1,328.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,532.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$759.40
|
| Rate for Payer: Multiplan Commercial |
$2,847.75
|
| Rate for Payer: Networks By Design Commercial |
$2,468.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,227.45
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,278.20
|
| Rate for Payer: Riverside University Health MISP |
$1,518.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,278.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,278.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,227.45
|
| Rate for Payer: Vantage Medical Group Senior |
$3,227.45
|
|
|
HC SICKLE CELL SCREEN
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$49.11 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$8.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.11
|
| Rate for Payer: BCBS Transplant 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 |
$5.51
|
| 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 |
$8.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.51
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.51
|
| 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 Transplant Other |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.04
|
| Rate for Payer: IEHP medi-cal |
$9.09
|
| Rate for Payer: IEHP Medicare Advantage |
$5.51
|
| Rate for Payer: Innovage PACE Commercial |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.38
|
| 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 |
$5.84
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: Riverside University Health MISP |
$6.06
|
| 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 |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC SICKLE CELL SCREEN
|
Facility
IP
|
$101.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
