|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
OP
|
$6,529.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,305.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,305.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,549.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,590.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,896.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,009.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,938.05
|
| Rate for Payer: Cash Price |
$2,938.05
|
| Rate for Payer: Cigna of CA HMO |
$4,178.56
|
| Rate for Payer: Cigna of CA PPO |
$4,831.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,549.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,549.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,549.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,611.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,611.60
|
| Rate for Payer: Galaxy Health WC |
$5,549.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,917.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,354.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,487.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,041.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,570.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,570.30
|
| Rate for Payer: Multiplan Commercial |
$5,223.20
|
| Rate for Payer: Networks By Design Commercial |
$4,243.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,549.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,917.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,264.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,549.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,549.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5,549.65
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
OP
|
$10,055.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,011.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,011.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,546.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,530.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,541.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,174.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,524.75
|
| Rate for Payer: Cash Price |
$4,524.75
|
| Rate for Payer: Cigna of CA HMO |
$6,435.20
|
| Rate for Payer: Cigna of CA PPO |
$7,440.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,546.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,546.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,546.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,022.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,022.00
|
| Rate for Payer: Galaxy Health WC |
$8,546.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,033.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,706.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,224.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,413.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,038.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,038.50
|
| Rate for Payer: Multiplan Commercial |
$8,044.00
|
| Rate for Payer: Networks By Design Commercial |
$6,535.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,546.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,033.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,027.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,027.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,027.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,027.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,546.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,546.75
|
| Rate for Payer: Vantage Medical Group Senior |
$8,546.75
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
IP
|
$10,055.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,011.00 |
| Max. Negotiated Rate |
$8,546.75 |
| Rate for Payer: Adventist Health Commercial |
$2,011.00
|
| Rate for Payer: Cash Price |
$4,524.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,022.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,022.00
|
| Rate for Payer: Galaxy Health WC |
$8,546.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,033.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,706.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,224.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,413.20
|
| Rate for Payer: Multiplan Commercial |
$8,044.00
|
| Rate for Payer: Networks By Design Commercial |
$6,535.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,546.75
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
IP
|
$87,123.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$17,424.60 |
| Max. Negotiated Rate |
$74,054.55 |
| Rate for Payer: Adventist Health Commercial |
$17,424.60
|
| Rate for Payer: Cash Price |
$39,205.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$34,849.20
|
| Rate for Payer: Galaxy Health WC |
$74,054.55
|
| Rate for Payer: Global Benefits Group Commercial |
$52,273.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58,111.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,193.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53,929.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,909.52
|
| Rate for Payer: Multiplan Commercial |
$69,698.40
|
| Rate for Payer: Networks By Design Commercial |
$56,629.95
|
| Rate for Payer: Prime Health Services Commercial |
$74,054.55
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
OP
|
$87,123.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$74,054.55 |
| Rate for Payer: Adventist Health Commercial |
$17,424.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74,054.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47,917.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65,342.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53,502.23
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$39,205.35
|
| Rate for Payer: Cash Price |
$39,205.35
|
| Rate for Payer: Cigna of CA HMO |
$55,758.72
|
| Rate for Payer: Cigna of CA PPO |
$64,471.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74,054.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$74,054.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74,054.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$34,849.20
|
| Rate for Payer: EPIC Health Plan Senior |
$34,849.20
|
| Rate for Payer: Galaxy Health WC |
$74,054.55
|
| Rate for Payer: Global Benefits Group Commercial |
$52,273.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58,111.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33,193.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53,929.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20,909.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60,986.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60,986.10
|
| Rate for Payer: Multiplan Commercial |
$69,698.40
|
| Rate for Payer: Networks By Design Commercial |
$56,629.95
|
| Rate for Payer: Prime Health Services Commercial |
$74,054.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52,273.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43,561.50
|
| Rate for Payer: United Healthcare All Other HMO |
$43,561.50
|
| Rate for Payer: United Healthcare HMO Rider |
$43,561.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43,561.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74,054.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74,054.55
|
| Rate for Payer: Vantage Medical Group Senior |
$74,054.55
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
IP
|
$10,055.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,011.00 |
| Max. Negotiated Rate |
$8,546.75 |
| Rate for Payer: Adventist Health Commercial |
$2,011.00
|
| Rate for Payer: Cash Price |
$4,524.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,022.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,022.00
|
| Rate for Payer: Galaxy Health WC |
$8,546.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,033.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,706.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,224.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,413.20
|
| Rate for Payer: Multiplan Commercial |
$8,044.00
|
| Rate for Payer: Networks By Design Commercial |
$6,535.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,546.75
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
OP
|
$10,055.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,011.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,011.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,546.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,530.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,541.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,174.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,524.75
|
| Rate for Payer: Cash Price |
$4,524.75
|
| Rate for Payer: Cigna of CA HMO |
$6,435.20
|
| Rate for Payer: Cigna of CA PPO |
$7,440.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,546.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,546.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,546.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,022.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,022.00
|
| Rate for Payer: Galaxy Health WC |
$8,546.75
|
| Rate for Payer: Global Benefits Group Commercial |
$6,033.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,706.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,830.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,224.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,413.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,038.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,038.50
|
| Rate for Payer: Multiplan Commercial |
$8,044.00
|
| Rate for Payer: Networks By Design Commercial |
$6,535.75
|
| Rate for Payer: Prime Health Services Commercial |
$8,546.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,033.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,027.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,027.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,027.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,027.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,546.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,546.75
|
| Rate for Payer: Vantage Medical Group Senior |
$8,546.75
|
|
|
HC SURGICAL BOOT CHILD EA
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT L3209
|
| Hospital Charge Code |
905353209
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$38.00
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
|
|
HC SURGICAL BOOT CHILD EA
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT L3209
|
| Hospital Charge Code |
905353209
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.24 |
| Max. Negotiated Rate |
$64.60 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.02
|
| Rate for Payer: Blue Shield of California Commercial |
$56.09
|
| Rate for Payer: Blue Shield of California EPN |
$36.94
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Networks By Design Commercial |
$38.00
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC SURGICAL BOOT INFANT EA
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT L3208
|
| Hospital Charge Code |
905353208
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.88 |
| Max. Negotiated Rate |
$37.24 |
| Rate for Payer: Adventist Health Commercial |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.43
|
| Rate for Payer: Blue Shield of California Commercial |
$27.31
|
| Rate for Payer: Blue Shield of California EPN |
$17.98
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO |
$25.90
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.90
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$18.50
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.89
|
| Rate for Payer: United Healthcare All Other HMO |
$13.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.45
|
| Rate for Payer: Vantage Medical Group Senior |
$31.45
|
|
|
HC SURGICAL BOOT INFANT EA
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT L3208
|
| Hospital Charge Code |
905353208
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cigna of CA HMO |
$25.90
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Networks By Design Commercial |
$18.50
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.89
|
| Rate for Payer: United Healthcare All Other HMO |
$13.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.12
|
|
|
HC SURGICAL BOOT JUNIOR, EA
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT L3211
|
| Hospital Charge Code |
905353211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Adventist Health Commercial |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.71
|
| Rate for Payer: Blue Shield of California Commercial |
$67.16
|
| Rate for Payer: Blue Shield of California EPN |
$44.23
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$39.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.70
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.15
|
| Rate for Payer: United Healthcare All Other HMO |
$33.24
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.35
|
| Rate for Payer: Vantage Medical Group Senior |
$77.35
|
|
|
HC SURGICAL BOOT JUNIOR, EA
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT L3211
|
| Hospital Charge Code |
905353211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.15
|
| Rate for Payer: United Healthcare All Other HMO |
$33.24
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.80
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
IP
|
$539.63
|
|
| Hospital Charge Code |
901698645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.93 |
| Max. Negotiated Rate |
$458.69 |
| Rate for Payer: Adventist Health Commercial |
$107.93
|
| Rate for Payer: Cash Price |
$242.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.85
|
| Rate for Payer: EPIC Health Plan Senior |
$215.85
|
| Rate for Payer: Galaxy Health WC |
$458.69
|
| Rate for Payer: Global Benefits Group Commercial |
$323.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.51
|
| Rate for Payer: Multiplan Commercial |
$431.70
|
| Rate for Payer: Networks By Design Commercial |
$350.76
|
| Rate for Payer: Prime Health Services Commercial |
$458.69
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
OP
|
$162.47
|
|
| Hospital Charge Code |
901698817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.77
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: Cigna of CA HMO |
$103.98
|
| Rate for Payer: Cigna of CA PPO |
$120.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.73
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.23
|
| Rate for Payer: United Healthcare All Other HMO |
$81.23
|
| Rate for Payer: United Healthcare HMO Rider |
$81.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.10
|
| Rate for Payer: Vantage Medical Group Senior |
$138.10
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
OP
|
$539.63
|
|
| Hospital Charge Code |
901698645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.93 |
| Max. Negotiated Rate |
$458.69 |
| Rate for Payer: Adventist Health Commercial |
$107.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$353.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$458.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$404.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$331.39
|
| Rate for Payer: Cash Price |
$242.83
|
| Rate for Payer: Cigna of CA HMO |
$345.36
|
| Rate for Payer: Cigna of CA PPO |
$399.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$458.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$458.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.85
|
| Rate for Payer: EPIC Health Plan Senior |
$215.85
|
| Rate for Payer: Galaxy Health WC |
$458.69
|
| Rate for Payer: Global Benefits Group Commercial |
$323.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$377.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$377.74
|
| Rate for Payer: Multiplan Commercial |
$431.70
|
| Rate for Payer: Networks By Design Commercial |
$350.76
|
| Rate for Payer: Prime Health Services Commercial |
$458.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$323.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$323.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.81
|
| Rate for Payer: United Healthcare All Other HMO |
$269.81
|
| Rate for Payer: United Healthcare HMO Rider |
$269.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$458.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.69
|
| Rate for Payer: Vantage Medical Group Senior |
$458.69
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
IP
|
$162.47
|
|
| Hospital Charge Code |
901698817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$138.10 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$73.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.99
|
| Rate for Payer: Multiplan Commercial |
$129.98
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
OP
|
$1,799.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$359.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,104.77
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: Cigna of CA HMO |
$1,151.36
|
| Rate for Payer: Cigna of CA PPO |
$1,331.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,199.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$1,439.20
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,079.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT 45355
|
| Hospital Charge Code |
906745355
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$338.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$929.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,267.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,037.83
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Cigna of CA HMO |
$1,081.60
|
| Rate for Payer: Cigna of CA PPO |
$1,250.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,183.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,183.00
|
| Rate for Payer: Multiplan Commercial |
$1,352.00
|
| Rate for Payer: Networks By Design Commercial |
$1,098.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$845.00
|
| Rate for Payer: United Healthcare All Other HMO |
$845.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$845.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,436.50
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
IP
|
$1,799.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$359.80 |
| Max. Negotiated Rate |
$1,529.15 |
| Rate for Payer: Adventist Health Commercial |
$359.80
|
| Rate for Payer: Cash Price |
$809.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$719.60
|
| Rate for Payer: EPIC Health Plan Senior |
$719.60
|
| Rate for Payer: Galaxy Health WC |
$1,529.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,079.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,199.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,113.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.76
|
| Rate for Payer: Multiplan Commercial |
$1,439.20
|
| Rate for Payer: Networks By Design Commercial |
$1,169.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,529.15
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
IP
|
$13,165.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,633.00 |
| Max. Negotiated Rate |
$11,190.25 |
| Rate for Payer: Adventist Health Commercial |
$2,633.00
|
| Rate for Payer: Cash Price |
$5,924.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,266.00
|
| Rate for Payer: Galaxy Health WC |
$11,190.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,899.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,015.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,149.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,159.60
|
| Rate for Payer: Multiplan Commercial |
$10,532.00
|
| Rate for Payer: Networks By Design Commercial |
$8,557.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,190.25
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
OP
|
$13,165.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,633.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,633.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,190.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,240.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,873.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,084.63
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,924.25
|
| Rate for Payer: Cash Price |
$5,924.25
|
| Rate for Payer: Cigna of CA HMO |
$8,425.60
|
| Rate for Payer: Cigna of CA PPO |
$9,742.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,190.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,190.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,190.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,266.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,266.00
|
| Rate for Payer: Galaxy Health WC |
$11,190.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,899.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,781.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,015.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,149.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,159.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,215.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,215.50
|
| Rate for Payer: Multiplan Commercial |
$10,532.00
|
| Rate for Payer: Networks By Design Commercial |
$8,557.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,190.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,899.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,582.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,582.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,582.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,582.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,190.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,190.25
|
| Rate for Payer: Vantage Medical Group Senior |
$11,190.25
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$279.80 |
| Max. Negotiated Rate |
$1,189.15 |
| Rate for Payer: Adventist Health Commercial |
$279.80
|
| Rate for Payer: Cash Price |
$629.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$559.60
|
| Rate for Payer: EPIC Health Plan Senior |
$559.60
|
| Rate for Payer: Galaxy Health WC |
$1,189.15
|
| Rate for Payer: Global Benefits Group Commercial |
$839.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$933.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$865.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.76
|
| Rate for Payer: Multiplan Commercial |
$1,119.20
|
| Rate for Payer: Networks By Design Commercial |
$909.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,189.15
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.33 |
| Max. Negotiated Rate |
$1,189.15 |
| Rate for Payer: Adventist Health Commercial |
$279.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$917.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.16
|
| Rate for Payer: Blue Shield of California Commercial |
$856.19
|
| Rate for Payer: Blue Shield of California EPN |
$565.20
|
| Rate for Payer: Cash Price |
$629.55
|
| Rate for Payer: Cash Price |
$629.55
|
| Rate for Payer: Cigna of CA HMO |
$895.36
|
| Rate for Payer: Cigna of CA PPO |
$1,035.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$1,189.15
|
| Rate for Payer: Global Benefits Group Commercial |
$839.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$24.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$933.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$1,119.20
|
| Rate for Payer: Networks By Design Commercial |
$909.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,189.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$839.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$839.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,088.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,088.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,088.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,088.13
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC SUSCEPTIBILITY PANEL YEAST
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900914672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
