|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
IP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$208.40 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$208.40
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.80
|
| Rate for Payer: EPIC Health Plan Senior |
$416.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$397.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
|
|
HC DVLP TEST PHYS/QHP ST 1ST HR
|
Facility
|
OP
|
$1,042.00
|
|
|
Service Code
|
CPT 96112
|
| Hospital Charge Code |
905601811
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$195.84 |
| Max. Negotiated Rate |
$885.70 |
| Rate for Payer: Adventist Health Commercial |
$427.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$683.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cash Price |
$468.90
|
| Rate for Payer: Cigna of CA HMO |
$666.88
|
| Rate for Payer: Cigna of CA PPO |
$771.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$885.70
|
| Rate for Payer: Global Benefits Group Commercial |
$625.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$195.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$695.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$250.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$833.60
|
| Rate for Payer: Networks By Design Commercial |
$677.30
|
| Rate for Payer: Prime Health Services Commercial |
$885.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$625.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC DVL TST PHY/QHP PT EA ADD 30 MIN
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
900496113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$129.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cigna of CA HMO |
$202.88
|
| Rate for Payer: Cigna of CA PPO |
$234.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$269.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$269.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$269.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.90
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.45
|
| Rate for Payer: Vantage Medical Group Senior |
$269.45
|
|
|
HC DVL TST PHY/QHP PT EA ADD 30 MIN
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
900496113
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$269.45 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
|
|
HC DVL TST PHY/QHP ST EA ADD 30 MIN
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
905696113
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$76.08 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$129.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$207.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$174.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$237.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: Cigna of CA HMO |
$202.88
|
| Rate for Payer: Cigna of CA PPO |
$234.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$269.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$269.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$269.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$221.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$221.90
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$190.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$190.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$269.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$269.45
|
| Rate for Payer: Vantage Medical Group Senior |
$269.45
|
|
|
HC DVL TST PHY/QHP ST EA ADD 30 MIN
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 96113
|
| Hospital Charge Code |
905696113
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$63.40 |
| Max. Negotiated Rate |
$269.45 |
| Rate for Payer: Adventist Health Commercial |
$63.40
|
| Rate for Payer: Cash Price |
$142.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.80
|
| Rate for Payer: EPIC Health Plan Senior |
$126.80
|
| Rate for Payer: Galaxy Health WC |
$269.45
|
| Rate for Payer: Global Benefits Group Commercial |
$190.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.08
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Networks By Design Commercial |
$206.05
|
| Rate for Payer: Prime Health Services Commercial |
$269.45
|
|
|
HC DYNAMIC PLYON
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
915355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.50
|
| Rate for Payer: Blue Shield of California Commercial |
$372.69
|
| Rate for Payer: Blue Shield of California EPN |
$245.43
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$207.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC DYNAMIC PLYON
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
905355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC DYNAMIC PLYON
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
915355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$101.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
|
|
HC DYNAMIC PLYON
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L5985
|
| Hospital Charge Code |
905355985
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.20 |
| Max. Negotiated Rate |
$429.25 |
| Rate for Payer: Adventist Health Commercial |
$207.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.50
|
| Rate for Payer: Blue Shield of California Commercial |
$372.69
|
| Rate for Payer: Blue Shield of California EPN |
$245.43
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Senior |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$207.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$336.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$234.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$312.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$353.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$353.50
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$189.53
|
| Rate for Payer: United Healthcare All Other HMO |
$184.48
|
| Rate for Payer: United Healthcare HMO Rider |
$180.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$4,250.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,896.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,690.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,335.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,905.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,095.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$4,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,250.00
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,335.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,905.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,095.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
OP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
905380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,200.00 |
| Max. Negotiated Rate |
$4,250.00 |
| Rate for Payer: Adventist Health Commercial |
$2,050.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,750.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,750.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,896.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,690.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,430.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,250.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,250.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,335.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,905.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,095.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,500.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,500.00
|
| Rate for Payer: Multiplan Commercial |
$4,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,000.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,000.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,250.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,250.00
|
|
|
HC DYNAMIC STABILITY CONTRL LE
|
Facility
|
IP
|
$5,000.00
|
|
|
Service Code
|
CPT L5999
|
| Hospital Charge Code |
915380023
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,000.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cash Price |
$2,250.00
|
| Rate for Payer: Cigna of CA HMO |
$3,500.00
|
| Rate for Payer: Cigna of CA PPO |
$3,500.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,000.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,000.00
|
| Rate for Payer: Galaxy Health WC |
$4,250.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,000.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,335.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,905.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,095.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,200.00
|
| Rate for Payer: Multiplan Commercial |
$4,000.00
|
| Rate for Payer: Networks By Design Commercial |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,250.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,876.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,826.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,787.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.50
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$323.75
|
| Rate for Payer: Blue Shield of California EPN |
$213.72
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Cigna of CA HMO |
$338.56
|
| Rate for Payer: Cigna of CA PPO |
$391.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$449.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$449.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$254.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$287.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$370.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$370.30
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$317.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$449.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.65
|
| Rate for Payer: Vantage Medical Group Senior |
$449.65
|
|
|
HC EA ADDL LESION MAMMO
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 19282
|
| Hospital Charge Code |
909019282
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$105.80 |
| Max. Negotiated Rate |
$449.65 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$211.60
|
| Rate for Payer: Galaxy Health WC |
$449.65
|
| Rate for Payer: Global Benefits Group Commercial |
$317.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$352.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$201.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Networks By Design Commercial |
$343.85
|
| Rate for Payer: Prime Health Services Commercial |
$449.65
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
IP
|
$1,414.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$1,201.90 |
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$538.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$875.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.36
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Networks By Design Commercial |
$919.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
|
|
HC EA ADDL LESION STEREO
|
Facility
|
OP
|
$1,414.00
|
|
|
Service Code
|
CPT 19284
|
| Hospital Charge Code |
909019284
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$282.80 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,201.90
|
| Rate for Payer: Adventist Health Commercial |
$282.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$777.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,060.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna of CA HMO |
$904.96
|
| Rate for Payer: Cigna of CA PPO |
$1,046.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,201.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$565.60
|
| Rate for Payer: EPIC Health Plan Senior |
$565.60
|
| Rate for Payer: Galaxy Health WC |
$1,201.90
|
| Rate for Payer: Global Benefits Group Commercial |
$848.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$312.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$943.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$875.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$339.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$989.80
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Networks By Design Commercial |
$919.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,201.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$848.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,201.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,201.90
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$91.80
|
| Rate for Payer: Blue Shield of California EPN |
$60.60
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna of CA HMO |
$96.00
|
| Rate for Payer: Cigna of CA PPO |
$111.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$127.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$127.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$127.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$104.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.00
|
| Rate for Payer: United Healthcare All Other HMO |
$75.00
|
| Rate for Payer: United Healthcare HMO Rider |
$75.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$127.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$127.50
|
| Rate for Payer: Vantage Medical Group Senior |
$127.50
|
|
|
HC EA ADDL MAGNETIC RESONANCE
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 19288
|
| Hospital Charge Code |
908819288
|
|
Hospital Revenue Code
|
614
|
| Min. Negotiated Rate |
$30.00 |
| Max. Negotiated Rate |
$127.50 |
| Rate for Payer: Adventist Health Commercial |
$30.00
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Senior |
$60.00
|
| Rate for Payer: Galaxy Health WC |
$127.50
|
| Rate for Payer: Global Benefits Group Commercial |
$90.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Networks By Design Commercial |
$97.50
|
| Rate for Payer: Prime Health Services Commercial |
$127.50
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$151.30 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC EA ADDL ULTRASOUND
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 19286
|
| Hospital Charge Code |
906619286
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$35.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.94
|
| Rate for Payer: Blue Shield of California EPN |
$71.91
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Senior |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$702.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$794.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$110.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.60
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.00
|
| Rate for Payer: United Healthcare All Other HMO |
$89.00
|
| Rate for Payer: United Healthcare HMO Rider |
$89.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC EBER
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
903800319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$357.08 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$118.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.56
|
| Rate for Payer: Blue Shield of California Commercial |
$121.09
|
| Rate for Payer: Blue Shield of California EPN |
$80.00
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC EBER
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT 88365
|
| Hospital Charge Code |
903800319
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
|
|
HC EBER, KAPPA, LAMBA
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 88364
|
| Hospital Charge Code |
903800320
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$85.20 |
| Max. Negotiated Rate |
$672.75 |
| Rate for Payer: Adventist Health Commercial |
$85.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$319.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$672.75
|
| Rate for Payer: Blue Shield of California Commercial |
$284.99
|
| Rate for Payer: Blue Shield of California EPN |
$188.29
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna of CA HMO |
$272.64
|
| Rate for Payer: Cigna of CA PPO |
$315.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.40
|
| Rate for Payer: EPIC Health Plan Senior |
$170.40
|
| Rate for Payer: Galaxy Health WC |
$362.10
|
| Rate for Payer: Global Benefits Group Commercial |
$255.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$284.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$263.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.20
|
| Rate for Payer: Multiplan Commercial |
$340.80
|
| Rate for Payer: Networks By Design Commercial |
$276.90
|
| Rate for Payer: Prime Health Services Commercial |
$362.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.77
|
| Rate for Payer: United Healthcare All Other HMO |
$85.77
|
| Rate for Payer: United Healthcare HMO Rider |
$85.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.10
|
| Rate for Payer: Vantage Medical Group Senior |
$362.10
|
|
