|
HC UNLIST PROC, PELVIS OR HIP JNT
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
900501429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$157.00 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
| 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
|
|
|
HC UNLIST PROC, PELVIS OR HIP JNT
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
900501429
|
|
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, SHOULDER
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
900501430
|
|
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, SHOULDER
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
900501430
|
|
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
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
| Rate for Payer: Adventist Health Commercial |
$341.60
|
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna of CA HMO |
$1,093.12
|
| Rate for Payer: Cigna of CA HMO |
$997.76
|
| Rate for Payer: Cigna of CA PPO |
$1,263.92
|
| Rate for Payer: Cigna of CA PPO |
$1,153.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,091.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,195.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$1,451.80
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$989.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,084.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Multiplan Commercial |
$1,247.20
|
| Rate for Payer: Multiplan WC |
$316.75
|
| Rate for Payer: Multiplan WC |
$316.75
|
| Rate for Payer: Networks By Design Commercial |
$1,013.35
|
| Rate for Payer: Networks By Design Commercial |
$1,110.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,325.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,451.80
|
| Rate for Payer: Prime Health Services WC |
$313.51
|
| Rate for Payer: Prime Health Services WC |
$313.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,024.80
|
| 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 Commercial |
$854.00
|
| Rate for Payer: United Healthcare All Other HMO |
$779.50
|
| Rate for Payer: United Healthcare All Other HMO |
$854.00
|
| Rate for Payer: United Healthcare HMO Rider |
$854.00
|
| Rate for Payer: United Healthcare HMO Rider |
$779.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$854.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$341.60
|
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,096.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,000.41
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| 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: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cigna of CA HMO |
$1,093.12
|
| Rate for Payer: Cigna of CA HMO |
$997.76
|
| Rate for Payer: Cigna of CA PPO |
$1,153.66
|
| Rate for Payer: Cigna of CA PPO |
$1,263.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,195.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,091.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Galaxy Health WC |
$1,451.80
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,024.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$989.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,084.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$374.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$409.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: Multiplan Commercial |
$1,247.20
|
| Rate for Payer: Networks By Design Commercial |
$1,110.20
|
| 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 Commercial |
$1,451.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,024.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$935.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$854.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$779.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| 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 HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,195.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,084.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,007.72
|
| 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
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,195.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,084.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,007.72
|
| 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 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 |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$101.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| 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 |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$430.10
|
| Rate for Payer: Global Benefits Group Commercial |
$303.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$321.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$321.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$298.54
|
| 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 PROCEDURE TRACHEA BRONC
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.73 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$357.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,147.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| 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 |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,251.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.60
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| 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/Senior |
$421.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,135.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$323.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$344.02
|
| 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 |
$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 |
$256.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,251.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,135.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,054.92
|
| 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 PROCEDURE TRACHEA BRONC
|
Facility
|
IP
|
$1,788.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
361
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,251.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,135.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,054.92
|
| 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 PROCEDURE TRACHEA BRONC
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$256.73 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$357.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| 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 |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,251.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.60
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| 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/Senior |
$421.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,135.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$275.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$323.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$344.02
|
| 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 |
$256.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.13
|
| 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 PROC PALATE/UVULA
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$49.68 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$84.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.77
|
| 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 |
$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 |
$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 |
$144.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| 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 |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.68
|
| 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 |
$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: TriValley Medical Group Commercial/Senior |
$124.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| 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 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 |
$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 |
$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 |
$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 |
$144.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$175.95
|
| Rate for Payer: Global Benefits Group Commercial |
$124.20
|
| 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 |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.68
|
| 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 |
$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 |
$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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$144.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$131.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.13
|
| 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
|
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 |
$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 |
$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 |
$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 |
$459.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| 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 |
$417.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.68
|
| 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 |
$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 |
$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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$459.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$417.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$387.63
|
| 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 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 |
$313.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| 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 |
$313.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$344.85
|
| Rate for Payer: EPIC Health Plan Senior |
$229.90
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$342.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$209.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$224.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$263.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$280.06
|
| 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 |
$209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$313.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Vantage Medical Group Senior |
$209.00
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.36
|
| 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 TONGUE FLOOR OF MOUTH
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$97.20 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$166.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$265.64
|
| 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 |
$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 |
$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 |
$283.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$344.25
|
| Rate for Payer: Global Benefits Group Commercial |
$243.00
|
| 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 |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.20
|
| 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 |
$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: TriValley Medical Group Commercial/Senior |
$243.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| 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 UNLST PROC TONGUE FLOOR OF MOUTH
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 41599
|
| Hospital Charge Code |
900501220
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$283.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$257.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.95
|
| 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
|
|
