|
HC ULTRASOUND RETROPERITONEAL COMPLETE
|
Facility
|
IP
|
$2,360.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
906601156
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$472.00 |
| Max. Negotiated Rate |
$2,006.00 |
| Rate for Payer: Adventist Health Commercial |
$472.00
|
| Rate for Payer: Cash Price |
$1,062.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$944.00
|
| Rate for Payer: EPIC Health Plan Senior |
$944.00
|
| Rate for Payer: Galaxy Health WC |
$2,006.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,416.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,498.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,392.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$566.40
|
| Rate for Payer: Multiplan Commercial |
$1,888.00
|
| Rate for Payer: Networks By Design Commercial |
$1,534.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,006.00
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
|
OP
|
$2,033.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Adventist Health Commercial |
$406.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$596.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,304.58
|
| Rate for Payer: Blue Shield of California Commercial |
$855.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,297.05
|
| Rate for Payer: Cash Price |
$914.85
|
| Rate for Payer: Cash Price |
$914.85
|
| Rate for Payer: Cigna of CA HMO |
$1,301.12
|
| Rate for Payer: Cigna of CA PPO |
$1,504.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,423.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,728.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,219.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,290.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,626.40
|
| Rate for Payer: Networks By Design Commercial |
$1,321.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,219.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,219.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASOUND RETROPERITONEAL LIMITED
|
Facility
|
IP
|
$2,033.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
906601162
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$406.60 |
| Max. Negotiated Rate |
$1,728.05 |
| Rate for Payer: Adventist Health Commercial |
$406.60
|
| Rate for Payer: Cash Price |
$914.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,423.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$813.20
|
| Rate for Payer: EPIC Health Plan Senior |
$813.20
|
| Rate for Payer: Galaxy Health WC |
$1,728.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,219.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,290.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,199.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$487.92
|
| Rate for Payer: Multiplan Commercial |
$1,626.40
|
| Rate for Payer: Networks By Design Commercial |
$1,321.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,728.05
|
|
|
HC ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
|
OP
|
$2,684.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$2,281.40 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$824.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,722.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,712.39
|
| Rate for Payer: Blue Shield of California Commercial |
$1,129.96
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Cigna of CA HMO |
$1,717.76
|
| Rate for Payer: Cigna of CA PPO |
$1,986.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,878.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$2,281.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,610.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$185.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,704.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$209.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: Networks By Design Commercial |
$1,744.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,281.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,610.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,610.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASOUND TRANSP KIDNEY W/DOPPLER
|
Facility
|
IP
|
$2,684.00
|
|
|
Service Code
|
CPT 76776
|
| Hospital Charge Code |
906601163
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$536.80 |
| Max. Negotiated Rate |
$2,281.40 |
| Rate for Payer: Adventist Health Commercial |
$536.80
|
| Rate for Payer: Cash Price |
$1,207.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,878.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,073.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,073.60
|
| Rate for Payer: Galaxy Health WC |
$2,281.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,610.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,704.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,583.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$644.16
|
| Rate for Payer: Multiplan Commercial |
$2,147.20
|
| Rate for Payer: Networks By Design Commercial |
$1,744.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,281.40
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$447.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,006.83
|
| Rate for Payer: Blue Shield of California Commercial |
$660.55
|
| Rate for Payer: Blue Shield of California Commercial |
$1,001.02
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$138.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$996.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$156.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.07
|
| Rate for Payer: United Healthcare All Other HMO |
$161.07
|
| Rate for Payer: United Healthcare HMO Rider |
$161.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$161.07
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC ULTRASOUND TRANSVAGINAL OB
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 76817
|
| Hospital Charge Code |
906601312
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,333.65 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: EPIC Health Plan Senior |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$996.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$925.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$376.56
|
| Rate for Payer: Multiplan Commercial |
$1,255.20
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$45.80 |
| Max. Negotiated Rate |
$194.65 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: EPIC Health Plan Senior |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.96
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
|
|
HC UMBILICAL VEIN CATH NEWBORN
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 36510
|
| Hospital Charge Code |
988136510
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$43.16 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$45.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cash Price |
$103.05
|
| Rate for Payer: Cigna of CA HMO |
$146.56
|
| Rate for Payer: Cigna of CA PPO |
$169.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$160.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.60
|
| Rate for Payer: EPIC Health Plan Senior |
$91.60
|
| Rate for Payer: Galaxy Health WC |
$194.65
|
| Rate for Payer: Global Benefits Group Commercial |
$137.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$160.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$160.30
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: Networks By Design Commercial |
$148.85
|
| Rate for Payer: Prime Health Services Commercial |
$194.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.50
|
| 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: Vantage Medical Group Commercial/Exchange |
$194.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.65
|
| Rate for Payer: Vantage Medical Group Senior |
$194.65
|
|
|
HC UNLISTED INVASIVE FETAL PROC
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC UNLISTED INVASIVE FETAL PROC
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$11,745.95 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,745.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.60
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.05
|
| Rate for Payer: EPIC Health Plan Senior |
$286.03
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$426.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$327.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC UNLISTED INVASIVE FETAL PROC ADD FETUS
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$399.50 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC UNLISTED INVASIVE FETAL PROC ADD FETUS
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 59897
|
| Hospital Charge Code |
910400097
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$11,745.95 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,745.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.60
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$390.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$286.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$260.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$429.05
|
| Rate for Payer: EPIC Health Plan Senior |
$286.03
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$426.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$260.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$364.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$327.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$348.44
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.00
|
| Rate for Payer: United Healthcare All Other HMO |
$235.00
|
| Rate for Payer: United Healthcare HMO Rider |
$235.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$260.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$390.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.03
|
| Rate for Payer: Vantage Medical Group Senior |
$260.03
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
|
IP
|
$4,652.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$930.40 |
| Max. Negotiated Rate |
$3,954.20 |
| Rate for Payer: Adventist Health Commercial |
$930.40
|
| Rate for Payer: Cash Price |
$2,093.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,256.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,860.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,860.80
|
| Rate for Payer: Galaxy Health WC |
$3,954.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,791.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,954.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,744.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.48
|
| Rate for Payer: Multiplan Commercial |
$3,721.60
|
| Rate for Payer: Networks By Design Commercial |
$3,023.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,954.20
|
|
|
HC UNLISTED OCULAR MUSCLE PROCEDU
|
Facility
|
OP
|
$4,652.00
|
|
|
Service Code
|
CPT 67399
|
| Hospital Charge Code |
900501657
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$408.24 |
| Max. Negotiated Rate |
$3,954.20 |
| Rate for Payer: Adventist Health Commercial |
$930.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,093.40
|
| Rate for Payer: Cash Price |
$2,093.40
|
| Rate for Payer: Cash Price |
$2,093.40
|
| Rate for Payer: Cigna of CA HMO |
$2,977.28
|
| Rate for Payer: Cigna of CA PPO |
$3,442.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,256.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$3,954.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,791.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,954.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,116.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$3,721.60
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$3,023.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,954.20
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,791.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,326.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,326.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,326.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,326.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
|
IP
|
$3,516.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$703.20 |
| Max. Negotiated Rate |
$2,988.60 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,461.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,406.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,406.40
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,232.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,074.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Networks By Design Commercial |
$2,285.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
|
|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
|
OP
|
$3,516.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$703.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cash Price |
$1,582.20
|
| Rate for Payer: Cigna of CA HMO |
$2,250.24
|
| Rate for Payer: Cigna of CA PPO |
$2,601.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,461.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$2,988.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,109.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,232.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$843.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$383.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$2,812.80
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,285.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,988.60
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,109.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,758.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,758.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,758.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,758.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC UNLISTED TX PROC 15MIN MCAL
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900400056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.36
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC UNLISTED TX PROC 15MIN MCAL
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900400056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$12.85 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$87.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$181.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.90
|
| Rate for Payer: Vantage Medical Group Senior |
$181.90
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.60 |
| Max. Negotiated Rate |
$1,260.55 |
| Rate for Payer: Adventist Health Commercial |
$296.60
|
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,038.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.20
|
| Rate for Payer: EPIC Health Plan Senior |
$593.20
|
| Rate for Payer: Galaxy Health WC |
$1,260.55
|
| Rate for Payer: Global Benefits Group Commercial |
$889.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$941.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$874.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.92
|
| Rate for Payer: Multiplan Commercial |
$1,186.40
|
| Rate for Payer: Networks By Design Commercial |
$963.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,260.55
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.60 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$296.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: Cash Price |
$667.35
|
| Rate for Payer: Cigna of CA HMO |
$949.12
|
| Rate for Payer: Cigna of CA PPO |
$1,097.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,038.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$1,260.55
|
| Rate for Payer: Global Benefits Group Commercial |
$889.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$941.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$1,186.40
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$963.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,260.55
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$889.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$741.50
|
| Rate for Payer: United Healthcare All Other HMO |
$741.50
|
| Rate for Payer: United Healthcare HMO Rider |
$741.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$741.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC UNLIST PROC, FOOT OR TOES
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
900501584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$667.25 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$549.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.00
|
| Rate for Payer: EPIC Health Plan Senior |
$314.00
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$498.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$463.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
|
|
HC UNLIST PROC, FOOT OR TOES
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
900501584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$157.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cash Price |
$353.25
|
| Rate for Payer: Cigna of CA HMO |
$502.40
|
| Rate for Payer: Cigna of CA PPO |
$580.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$549.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$667.25
|
| Rate for Payer: Global Benefits Group Commercial |
$471.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$498.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$510.25
|
| Rate for Payer: Prime Health Services Commercial |
$667.25
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$471.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$392.50
|
| Rate for Payer: United Healthcare All Other HMO |
$392.50
|
| Rate for Payer: United Healthcare HMO Rider |
$392.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$392.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC UNLIST PROC, HANDS OR FINGERS
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
900501535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$598.40 |
| Rate for Payer: Adventist Health Commercial |
$140.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.60
|
| Rate for Payer: EPIC Health Plan Senior |
$281.60
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$415.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.96
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
|
|
HC UNLIST PROC, HANDS OR FINGERS
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
900501535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$140.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cigna of CA HMO |
$450.56
|
| Rate for Payer: Cigna of CA PPO |
$520.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.00
|
| Rate for Payer: United Healthcare All Other HMO |
$352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$352.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
