|
HC EXPLORE KNEE I & D W/F.B. RMVL
|
Facility
|
IP
|
$12,040.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,408.00 |
| Max. Negotiated Rate |
$10,234.00 |
| Rate for Payer: Adventist Health Commercial |
$2,408.00
|
| Rate for Payer: Cash Price |
$6,622.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,816.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,816.00
|
| Rate for Payer: Galaxy Health WC |
$10,234.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,224.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,030.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,587.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,452.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,889.60
|
| Rate for Payer: Multiplan Commercial |
$9,632.00
|
| Rate for Payer: Networks By Design Commercial |
$7,826.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,234.00
|
|
|
HC EXPLORE LIMB VESSELS
|
Facility
|
OP
|
$6,067.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.12 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,213.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: Cigna of CA HMO |
$3,882.88
|
| Rate for Payer: Cigna of CA PPO |
$4,489.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,156.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,640.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,046.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,456.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$4,853.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$3,943.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,156.95
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,640.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,033.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,033.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,033.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,033.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC EXPLORE LIMB VESSELS
|
Facility
|
IP
|
$6,067.00
|
|
|
Service Code
|
CPT 35860
|
| Hospital Charge Code |
900501597
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,213.40 |
| Max. Negotiated Rate |
$5,156.95 |
| Rate for Payer: Adventist Health Commercial |
$1,213.40
|
| Rate for Payer: Cash Price |
$3,336.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,426.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,426.80
|
| Rate for Payer: Galaxy Health WC |
$5,156.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,640.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,046.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,311.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,755.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,456.08
|
| Rate for Payer: Multiplan Commercial |
$4,853.60
|
| Rate for Payer: Networks By Design Commercial |
$3,943.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,156.95
|
|
|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
IP
|
$5,675.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,135.00 |
| Max. Negotiated Rate |
$4,823.75 |
| Rate for Payer: Adventist Health Commercial |
$1,135.00
|
| Rate for Payer: Cash Price |
$3,121.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,270.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,270.00
|
| Rate for Payer: Galaxy Health WC |
$4,823.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,405.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,785.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,162.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,512.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Multiplan Commercial |
$4,540.00
|
| Rate for Payer: Networks By Design Commercial |
$3,688.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,823.75
|
|
|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
OP
|
$5,675.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$446.35 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,135.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$3,121.25
|
| Rate for Payer: Cash Price |
$3,121.25
|
| Rate for Payer: Cash Price |
$3,121.25
|
| Rate for Payer: Cigna of CA HMO |
$3,632.00
|
| Rate for Payer: Cigna of CA PPO |
$4,199.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$4,823.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,405.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,785.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$4,540.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$3,688.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,823.75
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,405.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,837.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,837.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,837.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,837.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
IP
|
$6,961.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,392.20 |
| Max. Negotiated Rate |
$5,916.85 |
| Rate for Payer: Adventist Health Commercial |
$1,392.20
|
| Rate for Payer: Cash Price |
$3,828.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,784.40
|
| Rate for Payer: Galaxy Health WC |
$5,916.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,176.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,652.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,308.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.64
|
| Rate for Payer: Multiplan Commercial |
$5,568.80
|
| Rate for Payer: Networks By Design Commercial |
$4,524.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,916.85
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
OP
|
$6,961.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$884.92 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,392.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,828.55
|
| Rate for Payer: Cash Price |
$3,828.55
|
| Rate for Payer: Cash Price |
$3,828.55
|
| Rate for Payer: Cigna of CA HMO |
$4,455.04
|
| Rate for Payer: Cigna of CA PPO |
$5,151.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$5,916.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,176.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,562.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$5,568.80
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,524.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,916.85
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,480.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,480.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,480.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,480.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$17,988.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,597.60 |
| Max. Negotiated Rate |
$15,289.80 |
| Rate for Payer: Adventist Health Commercial |
$3,597.60
|
| Rate for Payer: Cash Price |
$9,893.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,195.20
|
| Rate for Payer: Galaxy Health WC |
$15,289.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,792.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,998.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,853.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,134.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,317.12
|
| Rate for Payer: Multiplan Commercial |
$14,390.40
|
| Rate for Payer: Networks By Design Commercial |
$11,692.20
|
| Rate for Payer: Prime Health Services Commercial |
$15,289.80
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$24,336.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.86 |
| Max. Negotiated Rate |
$20,685.60 |
| Rate for Payer: Adventist Health Commercial |
$4,867.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,685.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,384.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,252.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$13,384.80
|
| Rate for Payer: Cash Price |
$13,384.80
|
| Rate for Payer: Cash Price |
$13,384.80
|
| Rate for Payer: Cigna of CA HMO |
$15,575.04
|
| Rate for Payer: Cigna of CA PPO |
$18,008.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,685.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,685.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,734.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,734.40
|
| Rate for Payer: Galaxy Health WC |
$20,685.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14,601.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,232.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,063.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,840.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,035.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,035.20
|
| Rate for Payer: Multiplan Commercial |
$19,468.80
|
| Rate for Payer: Networks By Design Commercial |
$15,818.40
|
| Rate for Payer: Prime Health Services Commercial |
$20,685.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,601.60
|
| 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 |
$20,685.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,685.60
|
| Rate for Payer: Vantage Medical Group Senior |
$20,685.60
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$24,336.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,867.20 |
| Max. Negotiated Rate |
$20,685.60 |
| Rate for Payer: Adventist Health Commercial |
$4,867.20
|
| Rate for Payer: Cash Price |
$13,384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,734.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,734.40
|
| Rate for Payer: Galaxy Health WC |
$20,685.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14,601.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,232.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,272.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,063.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,840.64
|
| Rate for Payer: Multiplan Commercial |
$19,468.80
|
| Rate for Payer: Networks By Design Commercial |
$15,818.40
|
| Rate for Payer: Prime Health Services Commercial |
$20,685.60
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$17,988.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$148.86 |
| Max. Negotiated Rate |
$15,289.80 |
| Rate for Payer: Adventist Health Commercial |
$3,597.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,289.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,893.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,491.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$9,893.40
|
| Rate for Payer: Cash Price |
$9,893.40
|
| Rate for Payer: Cash Price |
$9,893.40
|
| Rate for Payer: Cigna of CA HMO |
$11,512.32
|
| Rate for Payer: Cigna of CA PPO |
$13,311.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,289.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,289.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,195.20
|
| Rate for Payer: Galaxy Health WC |
$15,289.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,792.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,998.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,134.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,317.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,591.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,591.60
|
| Rate for Payer: Multiplan Commercial |
$14,390.40
|
| Rate for Payer: Networks By Design Commercial |
$11,692.20
|
| Rate for Payer: Prime Health Services Commercial |
$15,289.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,792.80
|
| 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 |
$15,289.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,289.80
|
| Rate for Payer: Vantage Medical Group Senior |
$15,289.80
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$636.65 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$491.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$411.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$561.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.96
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: Cigna of CA HMO |
$479.36
|
| Rate for Payer: Cigna of CA PPO |
$554.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$636.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$636.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$636.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.60
|
| Rate for Payer: EPIC Health Plan Senior |
$299.60
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$463.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$524.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$524.30
|
| Rate for Payer: Multiplan Commercial |
$599.20
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$449.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$449.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$374.50
|
| Rate for Payer: United Healthcare All Other HMO |
$374.50
|
| Rate for Payer: United Healthcare HMO Rider |
$374.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$374.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$636.65
|
| Rate for Payer: Vantage Medical Group Senior |
$636.65
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$636.65 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Cash Price |
$411.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.60
|
| Rate for Payer: EPIC Health Plan Senior |
$299.60
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$463.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.76
|
| Rate for Payer: Multiplan Commercial |
$599.20
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
905352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| 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 Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$90.50
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
905352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Adventist Health Commercial |
$74.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.84
|
| Rate for Payer: Blue Shield of California Commercial |
$133.58
|
| Rate for Payer: Blue Shield of California EPN |
$87.97
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.85
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.70
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$90.50
|
| 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 |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.85
|
| Rate for Payer: Vantage Medical Group Senior |
$153.85
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
915352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.44 |
| Max. Negotiated Rate |
$153.85 |
| Rate for Payer: Adventist Health Commercial |
$74.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.84
|
| Rate for Payer: Blue Shield of California Commercial |
$133.58
|
| Rate for Payer: Blue Shield of California EPN |
$87.97
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.85
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.70
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$90.50
|
| 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 |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.85
|
| Rate for Payer: Vantage Medical Group Senior |
$153.85
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
915352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| 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 Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA 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 |
$90.50
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$222.50
|
| Rate for Payer: United Healthcare HMO Rider |
$222.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$4,848.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$969.60 |
| Max. Negotiated Rate |
$4,120.80 |
| Rate for Payer: Adventist Health Commercial |
$969.60
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,939.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,939.20
|
| Rate for Payer: Galaxy Health WC |
$4,120.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,908.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,233.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,847.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,000.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.52
|
| Rate for Payer: Multiplan Commercial |
$3,878.40
|
| Rate for Payer: Networks By Design Commercial |
$3,151.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,120.80
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$4,848.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$969.60 |
| Max. Negotiated Rate |
$4,120.80 |
| Rate for Payer: Adventist Health Commercial |
$969.60
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,939.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,939.20
|
| Rate for Payer: Galaxy Health WC |
$4,120.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,908.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,233.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,847.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,000.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.52
|
| Rate for Payer: Multiplan Commercial |
$3,878.40
|
| Rate for Payer: Networks By Design Commercial |
$3,151.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,120.80
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$4,848.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$11,413.00 |
| Rate for Payer: Adventist Health Commercial |
$969.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,179.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,413.00
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cigna of CA HMO |
$3,102.72
|
| Rate for Payer: Cigna of CA PPO |
$3,587.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$4,120.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,908.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,233.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$3,878.40
|
| Rate for Payer: Networks By Design Commercial |
$3,151.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,120.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,908.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,908.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$4,848.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$969.60 |
| Max. Negotiated Rate |
$11,413.00 |
| Rate for Payer: Adventist Health Commercial |
$969.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,179.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,413.00
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cash Price |
$2,666.40
|
| Rate for Payer: Cigna of CA HMO |
$3,102.72
|
| Rate for Payer: Cigna of CA PPO |
$3,587.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$4,120.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,908.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,233.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$3,878.40
|
| Rate for Payer: Networks By Design Commercial |
$3,151.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,120.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,908.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,908.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,424.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,424.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,424.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC EXT POST MAST GRMNT
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L8015
|
| Hospital Charge Code |
915368015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC EXT POST MAST GRMNT
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L8015
|
| Hospital Charge Code |
905368015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
