|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$957.38
|
| 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 |
$701.55
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cigna of CA HMO |
$997.76
|
| Rate for Payer: Cigna of CA PPO |
$1,153.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,039.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$1,247.20
|
| Rate for Payer: Networks By Design Commercial |
$1,013.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,325.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$935.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$341.60 |
| Max. Negotiated Rate |
$1,451.80 |
| Rate for Payer: Adventist Health Commercial |
$341.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$683.20
|
| Rate for Payer: EPIC Health Plan Senior |
$683.20
|
| Rate for Payer: Galaxy Health WC |
$1,451.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,139.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$650.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,057.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Networks By Design Commercial |
$1,110.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,451.80
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cigna of CA HMO |
$997.76
|
| Rate for Payer: Cigna of CA PPO |
$1,153.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,039.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$1,247.20
|
| Rate for Payer: Multiplan WC |
$316.75
|
| Rate for Payer: Networks By Design Commercial |
$1,013.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,325.15
|
| Rate for Payer: Prime Health Services WC |
$313.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$935.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$779.50
|
| Rate for Payer: United Healthcare All Other HMO |
$779.50
|
| Rate for Payer: United Healthcare HMO Rider |
$779.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC UNLSTD MALE GENITAL SURG PROC
|
Facility
|
IP
|
$506.00
|
|
|
Service Code
|
CPT 55899
|
| Hospital Charge Code |
900501624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$430.10 |
| Rate for Payer: Adventist Health Commercial |
$101.20
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.40
|
| Rate for Payer: EPIC Health Plan Senior |
$202.40
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
|
|
HC UNLSTD MALE GENITAL SURG PROC
|
Facility
|
OP
|
$506.00
|
|
|
Service Code
|
CPT 55899
|
| Hospital Charge Code |
900501624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$101.20 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$101.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna of CA HMO |
$323.84
|
| Rate for Payer: Cigna of CA PPO |
$374.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$337.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$404.80
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$328.90
|
| Rate for Payer: Prime Health Services Commercial |
$430.10
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.00
|
| Rate for Payer: United Healthcare All Other HMO |
$253.00
|
| Rate for Payer: United Healthcare HMO Rider |
$253.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC UNLSTD PROCEDURE TRACHEA BRONC
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.67 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$357.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: Cigna of CA HMO |
$1,144.32
|
| Rate for Payer: Cigna of CA PPO |
$1,323.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| Rate for Payer: Galaxy Health WC |
$1,519.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,192.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$310.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| Rate for Payer: Multiplan Commercial |
$1,430.40
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$1,162.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,519.80
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,072.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$894.00
|
| Rate for Payer: United Healthcare All Other HMO |
$894.00
|
| Rate for Payer: United Healthcare HMO Rider |
$894.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC UNLSTD PROCEDURE TRACHEA BRONC
|
Facility
|
IP
|
$1,788.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$357.60 |
| Max. Negotiated Rate |
$1,519.80 |
| Rate for Payer: Adventist Health Commercial |
$357.60
|
| Rate for Payer: Cash Price |
$804.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$715.20
|
| Rate for Payer: EPIC Health Plan Senior |
$715.20
|
| Rate for Payer: Galaxy Health WC |
$1,519.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,072.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,192.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$681.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,106.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.12
|
| Rate for Payer: Multiplan Commercial |
$1,430.40
|
| Rate for Payer: Networks By Design Commercial |
$1,162.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,519.80
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: Cigna of CA HMO |
$132.48
|
| Rate for Payer: Cigna of CA PPO |
$153.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$103.50
|
| Rate for Payer: United Healthcare All Other HMO |
$103.50
|
| Rate for Payer: United Healthcare HMO Rider |
$103.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$103.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$41.40 |
| Max. Negotiated Rate |
$175.95 |
| Rate for Payer: Adventist Health Commercial |
$41.40
|
| Rate for Payer: Cash Price |
$93.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.80
|
| Rate for Payer: EPIC Health Plan Senior |
$82.80
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Networks By Design Commercial |
$134.55
|
| Rate for Payer: Prime Health Services Commercial |
$175.95
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$558.45 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.68
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: Networks By Design Commercial |
$427.05
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Cigna of CA HMO |
$420.48
|
| Rate for Payer: Cigna of CA PPO |
$486.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$525.60
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$427.05
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.50
|
| Rate for Payer: United Healthcare All Other HMO |
$328.50
|
| Rate for Payer: United Healthcare HMO Rider |
$328.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
IP
|
$504.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
OP
|
$504.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$200.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$300.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$270.66
|
| Rate for Payer: EPIC Health Plan Senior |
$200.49
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$328.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$200.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$200.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$252.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$268.66
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Multiplan WC |
$319.45
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Prime Health Services WC |
$316.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$200.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$300.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.54
|
| Rate for Payer: Vantage Medical Group Senior |
$200.49
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: Cigna of CA HMO |
$259.20
|
| Rate for Payer: Cigna of CA PPO |
$299.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$202.50
|
| Rate for Payer: United Healthcare All Other HMO |
$202.50
|
| Rate for Payer: United Healthcare HMO Rider |
$202.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$202.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.00 |
| Max. Negotiated Rate |
$344.25 |
| Rate for Payer: Adventist Health Commercial |
$81.00
|
| Rate for Payer: Cash Price |
$182.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.00
|
| Rate for Payer: EPIC Health Plan Senior |
$162.00
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| Rate for Payer: Multiplan Commercial |
$324.00
|
| Rate for Payer: Networks By Design Commercial |
$263.25
|
| Rate for Payer: Prime Health Services Commercial |
$344.25
|
|
|
HC UNOS REGISTRATION HEART
|
Facility
|
IP
|
$1,140.00
|
|
| Hospital Charge Code |
902200120
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
|
|
HC UNOS REGISTRATION HEART
|
Facility
|
OP
|
$1,140.00
|
|
| Hospital Charge Code |
902200120
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$747.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$627.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$855.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$700.07
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO |
$729.60
|
| Rate for Payer: Cigna of CA PPO |
$843.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$969.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$570.00
|
| Rate for Payer: United Healthcare HMO Rider |
$570.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.00
|
| Rate for Payer: Vantage Medical Group Senior |
$969.00
|
|
|
HC UNOS REGISTRATION KIDNEY
|
Facility
|
IP
|
$1,140.00
|
|
| Hospital Charge Code |
904700020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
|
|
HC UNOS REGISTRATION KIDNEY
|
Facility
|
OP
|
$1,140.00
|
|
| Hospital Charge Code |
904700020
|
|
Hospital Revenue Code
|
810
|
| Min. Negotiated Rate |
$228.00 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Adventist Health Commercial |
$228.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$747.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$627.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$855.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$700.07
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna of CA HMO |
$729.60
|
| Rate for Payer: Cigna of CA PPO |
$843.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$969.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$969.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$969.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$456.00
|
| Rate for Payer: EPIC Health Plan Senior |
$456.00
|
| Rate for Payer: Galaxy Health WC |
$969.00
|
| Rate for Payer: Global Benefits Group Commercial |
$684.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$760.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$434.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$705.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$273.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$798.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$798.00
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$741.00
|
| Rate for Payer: Prime Health Services Commercial |
$969.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$684.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$684.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$570.00
|
| Rate for Payer: United Healthcare HMO Rider |
$570.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$969.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$969.00
|
| Rate for Payer: Vantage Medical Group Senior |
$969.00
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$95.09 |
| Max. Negotiated Rate |
$1,610.00 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,071.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,003.44
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: Cigna of CA HMO |
$1,045.76
|
| Rate for Payer: Cigna of CA PPO |
$1,209.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$95.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,089.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,120.22
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$980.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$980.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,610.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,170.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,072.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
HC UNSCHED DIALYSIS ESRD PT OP
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
940100257
|
|
Hospital Revenue Code
|
829
|
| Min. Negotiated Rate |
$326.80 |
| Max. Negotiated Rate |
$1,388.90 |
| Rate for Payer: Adventist Health Commercial |
$326.80
|
| Rate for Payer: Cash Price |
$735.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$653.60
|
| Rate for Payer: EPIC Health Plan Senior |
$653.60
|
| Rate for Payer: Galaxy Health WC |
$1,388.90
|
| Rate for Payer: Global Benefits Group Commercial |
$980.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,089.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$622.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,011.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.16
|
| Rate for Payer: Multiplan Commercial |
$1,307.20
|
| Rate for Payer: Networks By Design Commercial |
$1,062.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,388.90
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
905356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Adventist Health Commercial |
$61.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.46
|
| Rate for Payer: Blue Shield of California Commercial |
$111.44
|
| Rate for Payer: Blue Shield of California EPN |
$73.39
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$93.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.70
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.35
|
| Rate for Payer: Vantage Medical Group Senior |
$128.35
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
905356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$93.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
915356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$128.35 |
| Rate for Payer: Adventist Health Commercial |
$61.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.46
|
| Rate for Payer: Blue Shield of California Commercial |
$111.44
|
| Rate for Payer: Blue Shield of California EPN |
$73.39
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$93.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.70
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.35
|
| Rate for Payer: Vantage Medical Group Senior |
$128.35
|
|
|
HC UPPER EXT ADD'L DISCNCT INSERT
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT L6616
|
| Hospital Charge Code |
915356616
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Cigna of CA HMO |
$105.70
|
| Rate for Payer: Cigna of CA PPO |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$100.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$93.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.24
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Networks By Design Commercial |
$75.50
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.67
|
| Rate for Payer: United Healthcare All Other HMO |
$55.16
|
| Rate for Payer: United Healthcare HMO Rider |
$53.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.45
|
|
