|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,078.88 |
| Max. Negotiated Rate |
$17,987.70 |
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,464.80
|
| Rate for Payer: Galaxy Health WC |
$17,987.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,697.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,115.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,062.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,078.88
|
| Rate for Payer: Multiplan Commercial |
$16,929.60
|
| Rate for Payer: Networks By Design Commercial |
$13,755.30
|
| Rate for Payer: Prime Health Services Commercial |
$17,987.70
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$21,162.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$17,987.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,639.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,639.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,697.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cash Price |
$9,522.90
|
| Rate for Payer: Cigna of CA PPO |
$15,659.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Dignity Health Media |
$17,987.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,987.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,464.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,464.80
|
| Rate for Payer: Galaxy Health WC |
$17,987.70
|
| Rate for Payer: Global Benefits Group Commercial |
$12,697.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15,871.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,115.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,078.88
|
| Rate for Payer: Multiplan Commercial |
$16,929.60
|
| Rate for Payer: Networks By Design Commercial |
$13,755.30
|
| Rate for Payer: Prime Health Services Commercial |
$17,987.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,697.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,987.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,987.70
|
| Rate for Payer: Vantage Medical Group Senior |
$17,987.70
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$469.20 |
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.80
|
| Rate for Payer: Galaxy Health WC |
$469.20
|
| Rate for Payer: Global Benefits Group Commercial |
$331.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.48
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: Networks By Design Commercial |
$358.80
|
| Rate for Payer: Prime Health Services Commercial |
$469.20
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.48 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$331.20
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna of CA PPO |
$408.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$469.20
|
| Rate for Payer: Global Benefits Group Commercial |
$331.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$414.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$500.51
|
| Rate for Payer: Heritage Provider Network Transplant |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$368.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$384.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: Networks By Design Commercial |
$358.80
|
| Rate for Payer: Prime Health Services Commercial |
$469.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$331.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$276.00
|
| Rate for Payer: United Healthcare All Other HMO |
$276.00
|
| Rate for Payer: United Healthcare HMO Rider |
$276.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$6,005.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$10,541.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$593.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,541.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,603.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,425.68
|
| Rate for Payer: Blue Shield of California EPN |
$3,506.92
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Cigna of CA HMO |
$3,843.20
|
| Rate for Payer: Cigna of CA PPO |
$4,443.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$5,104.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,603.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,503.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,005.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,287.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$4,804.00
|
| Rate for Payer: Networks By Design Commercial |
$3,903.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,104.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,603.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,603.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$6,005.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,441.20 |
| Max. Negotiated Rate |
$5,104.25 |
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,402.00
|
| Rate for Payer: Galaxy Health WC |
$5,104.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,603.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,005.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,287.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.20
|
| Rate for Payer: Multiplan Commercial |
$4,804.00
|
| Rate for Payer: Networks By Design Commercial |
$3,903.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,104.25
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$6,005.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,441.20 |
| Max. Negotiated Rate |
$5,104.25 |
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,402.00
|
| Rate for Payer: Galaxy Health WC |
$5,104.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,603.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,005.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,287.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.20
|
| Rate for Payer: Multiplan Commercial |
$4,804.00
|
| Rate for Payer: Networks By Design Commercial |
$3,903.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,104.25
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$6,005.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$593.86 |
| Max. Negotiated Rate |
$10,541.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$593.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,541.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,603.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,425.68
|
| Rate for Payer: Blue Shield of California EPN |
$3,506.92
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Cash Price |
$2,702.25
|
| Rate for Payer: Cigna of CA HMO |
$3,843.20
|
| Rate for Payer: Cigna of CA PPO |
$4,443.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$5,104.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,603.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,503.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,406.14
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$6,328.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,005.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,287.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,441.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,921.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$4,804.00
|
| Rate for Payer: Networks By Design Commercial |
$3,903.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,104.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,603.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,603.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,002.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,002.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,002.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,002.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.66 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$989.40
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: Cigna of CA PPO |
$1,220.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,236.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,127.40
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$866.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$1,319.20
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$989.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$824.50
|
| Rate for Payer: United Healthcare All Other HMO |
$824.50
|
| Rate for Payer: United Healthcare HMO Rider |
$824.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$824.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$395.76 |
| Max. Negotiated Rate |
$1,401.65 |
| Rate for Payer: Cash Price |
$742.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.60
|
| Rate for Payer: Galaxy Health WC |
$1,401.65
|
| Rate for Payer: Global Benefits Group Commercial |
$989.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$628.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.76
|
| Rate for Payer: Multiplan Commercial |
$1,319.20
|
| Rate for Payer: Networks By Design Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,401.65
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
OP
|
$5,682.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$6,597.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,409.20
|
| Rate for Payer: Cash Price |
$2,556.90
|
| Rate for Payer: Cash Price |
$2,556.90
|
| Rate for Payer: Cash Price |
$2,556.90
|
| Rate for Payer: Cigna of CA PPO |
$4,204.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$4,829.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,409.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,261.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,597.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,363.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$4,545.60
|
| Rate for Payer: Networks By Design Commercial |
$3,693.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,829.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,409.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,841.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,841.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,841.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,841.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
IP
|
$5,682.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,363.68 |
| Max. Negotiated Rate |
$4,829.70 |
| Rate for Payer: Cash Price |
$2,556.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,272.80
|
| Rate for Payer: Galaxy Health WC |
$4,829.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,409.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,789.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,164.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,363.68
|
| Rate for Payer: Multiplan Commercial |
$4,545.60
|
| Rate for Payer: Networks By Design Commercial |
$3,693.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,829.70
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
OP
|
$1,170.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
900803201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$184.98 |
| Max. Negotiated Rate |
$1,507.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,020.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$697.09
|
| Rate for Payer: Blue Distinction Transplant |
$702.00
|
| Rate for Payer: Blue Shield of California Commercial |
$691.47
|
| Rate for Payer: Blue Shield of California EPN |
$548.73
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Cigna of CA HMO |
$748.80
|
| Rate for Payer: Cigna of CA PPO |
$865.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$292.76
|
| Rate for Payer: Dignity Health Media |
$195.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$263.48
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$195.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$195.17
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$877.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$320.08
|
| Rate for Payer: Heritage Provider Network Transplant |
$320.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$316.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$195.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$195.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.53
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$702.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$702.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$292.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.69
|
| Rate for Payer: Vantage Medical Group Senior |
$195.17
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
900803201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$280.80 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,688.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: Cigna of CA PPO |
$3,315.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$3,808.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,688.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,360.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,788.26
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,678.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$3,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,240.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,240.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,240.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,240.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$4,480.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,075.20 |
| Max. Negotiated Rate |
$3,808.00 |
| Rate for Payer: Cash Price |
$2,016.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,792.00
|
| Rate for Payer: Galaxy Health WC |
$3,808.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,688.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,706.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.20
|
| Rate for Payer: Multiplan Commercial |
$3,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.89 |
| Max. Negotiated Rate |
$435.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$128.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.93
|
| Rate for Payer: Blue Distinction Transplant |
$307.20
|
| Rate for Payer: Blue Shield of California Commercial |
$302.59
|
| Rate for Payer: Blue Shield of California EPN |
$240.13
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna of CA HMO |
$327.68
|
| Rate for Payer: Cigna of CA PPO |
$378.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$384.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$186.21
|
| Rate for Payer: Heritage Provider Network Transplant |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$183.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$143.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$409.60
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$307.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.88 |
| Max. Negotiated Rate |
$435.20 |
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.88
|
| Rate for Payer: Multiplan Commercial |
$409.60
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
OP
|
$6,334.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$5,383.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,800.40
|
| Rate for Payer: Cash Price |
$2,850.30
|
| Rate for Payer: Cash Price |
$2,850.30
|
| Rate for Payer: Cash Price |
$2,850.30
|
| Rate for Payer: Cigna of CA PPO |
$4,687.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$5,383.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,800.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,750.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,775.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,520.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$5,067.20
|
| Rate for Payer: Networks By Design Commercial |
$4,117.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,383.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,800.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,167.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,167.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,167.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,167.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
IP
|
$6,334.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,520.16 |
| Max. Negotiated Rate |
$5,383.90 |
| Rate for Payer: Cash Price |
$2,850.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,533.60
|
| Rate for Payer: Galaxy Health WC |
$5,383.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,800.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,224.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,413.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,520.16
|
| Rate for Payer: Multiplan Commercial |
$5,067.20
|
| Rate for Payer: Networks By Design Commercial |
$4,117.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,383.90
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
OP
|
$7,266.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,911.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,282.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,359.60
|
| Rate for Payer: Cash Price |
$3,269.70
|
| Rate for Payer: Cash Price |
$3,269.70
|
| Rate for Payer: Cash Price |
$3,269.70
|
| Rate for Payer: Cigna of CA PPO |
$5,376.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Dignity Health Media |
$2,911.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,202.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,930.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,911.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,911.63
|
| Rate for Payer: Galaxy Health WC |
$6,176.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,359.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,449.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,775.07
|
| Rate for Payer: Heritage Provider Network Transplant |
$4,775.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,911.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,846.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,911.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,743.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,668.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,901.58
|
| Rate for Payer: Multiplan Commercial |
$5,812.80
|
| Rate for Payer: Networks By Design Commercial |
$4,722.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,176.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,359.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,633.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,367.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,202.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2,911.63
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
IP
|
$7,266.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,743.84 |
| Max. Negotiated Rate |
$6,176.10 |
| Rate for Payer: Cash Price |
$3,269.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,906.40
|
| Rate for Payer: Galaxy Health WC |
$6,176.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,359.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,846.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,768.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,743.84
|
| Rate for Payer: Multiplan Commercial |
$5,812.80
|
| Rate for Payer: Networks By Design Commercial |
$4,722.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,176.10
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$59.04 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$147.60
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Media |
$37.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$184.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$61.01
|
| Rate for Payer: Heritage Provider Network Transplant |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.00
|
| Rate for Payer: United Healthcare All Other HMO |
$123.00
|
| Rate for Payer: United Healthcare HMO Rider |
$123.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
IP
|
$1,403.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.72 |
| Max. Negotiated Rate |
$1,192.55 |
| Rate for Payer: Cash Price |
$631.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.20
|
| Rate for Payer: Galaxy Health WC |
$1,192.55
|
| Rate for Payer: Global Benefits Group Commercial |
$841.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$935.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.72
|
| Rate for Payer: Multiplan Commercial |
$1,122.40
|
| Rate for Payer: Networks By Design Commercial |
$911.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,192.55
|
|
