|
HC EXT POST MAST GRMNT
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L8015
|
| Hospital Charge Code |
915368015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.71
|
| Rate for Payer: Blue Shield of California Commercial |
$81.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| 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: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.72
|
| 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: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC EXT POST MAST GRMNT
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L8015
|
| Hospital Charge Code |
905368015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.71
|
| Rate for Payer: Blue Shield of California Commercial |
$81.18
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| 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: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.72
|
| 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: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.00
|
| 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: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
OP
|
$1,612.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.66 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$322.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$886.60
|
| Rate for Payer: Cash Price |
$886.60
|
| Rate for Payer: Cash Price |
$886.60
|
| Rate for Payer: Cigna of CA HMO |
$1,031.68
|
| Rate for Payer: Cigna of CA PPO |
$1,192.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$1,370.20
|
| Rate for Payer: Global Benefits Group Commercial |
$967.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,075.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$1,289.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,047.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,370.20
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$967.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$806.00
|
| Rate for Payer: United Healthcare All Other HMO |
$806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$806.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$806.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
IP
|
$1,612.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$322.40 |
| Max. Negotiated Rate |
$1,370.20 |
| Rate for Payer: Adventist Health Commercial |
$322.40
|
| Rate for Payer: Cash Price |
$886.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$644.80
|
| Rate for Payer: EPIC Health Plan Senior |
$644.80
|
| Rate for Payer: Galaxy Health WC |
$1,370.20
|
| Rate for Payer: Global Benefits Group Commercial |
$967.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,075.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$614.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$997.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.88
|
| Rate for Payer: Multiplan Commercial |
$1,289.60
|
| Rate for Payer: Networks By Design Commercial |
$1,047.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,370.20
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
OP
|
$4,830.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$6,757.85 |
| Rate for Payer: Adventist Health Commercial |
$966.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,656.50
|
| Rate for Payer: Cash Price |
$2,656.50
|
| Rate for Payer: Cash Price |
$2,656.50
|
| Rate for Payer: Cigna of CA HMO |
$3,091.20
|
| Rate for Payer: Cigna of CA PPO |
$3,574.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$4,105.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,898.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,221.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,159.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$3,864.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,139.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,105.50
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,898.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,415.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
IP
|
$4,830.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$966.00 |
| Max. Negotiated Rate |
$4,105.50 |
| Rate for Payer: Adventist Health Commercial |
$966.00
|
| Rate for Payer: Cash Price |
$2,656.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,932.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,932.00
|
| Rate for Payer: Galaxy Health WC |
$4,105.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,898.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,221.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,840.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,989.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,159.20
|
| Rate for Payer: Multiplan Commercial |
$3,864.00
|
| Rate for Payer: Networks By Design Commercial |
$3,139.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,105.50
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
OP
|
$994.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
900803201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$163.56 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$651.96
|
| 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 |
$610.42
|
| Rate for Payer: Blue Shield of California Commercial |
$608.33
|
| Rate for Payer: Blue Shield of California EPN |
$401.58
|
| Rate for Payer: Cash Price |
$546.70
|
| Rate for Payer: Cash Price |
$546.70
|
| Rate for Payer: Cash Price |
$546.70
|
| Rate for Payer: Cigna of CA HMO |
$636.16
|
| Rate for Payer: Cigna of CA PPO |
$735.56
|
| 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 |
$844.90
|
| Rate for Payer: Global Benefits Group Commercial |
$596.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$163.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.56
|
| 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 |
$795.20
|
| Rate for Payer: Networks By Design Commercial |
$646.10
|
| Rate for Payer: Prime Health Services Commercial |
$844.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$596.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$596.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| 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 EXTREMITY STUDY COMPLEX
|
Facility
|
IP
|
$994.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
900803201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$844.90 |
| Rate for Payer: Adventist Health Commercial |
$198.80
|
| Rate for Payer: Cash Price |
$546.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$397.60
|
| Rate for Payer: EPIC Health Plan Senior |
$397.60
|
| Rate for Payer: Galaxy Health WC |
$844.90
|
| Rate for Payer: Global Benefits Group Commercial |
$596.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$615.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.56
|
| Rate for Payer: Multiplan Commercial |
$795.20
|
| Rate for Payer: Networks By Design Commercial |
$646.10
|
| Rate for Payer: Prime Health Services Commercial |
$844.90
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$4,480.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$896.00 |
| Max. Negotiated Rate |
$3,808.00 |
| Rate for Payer: Adventist Health Commercial |
$896.00
|
| Rate for Payer: Cash Price |
$2,464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,792.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,792.00
|
| Rate for Payer: Galaxy Health WC |
$3,808.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,688.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,706.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,773.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.20
|
| Rate for Payer: Multiplan Commercial |
$3,584.00
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$4,480.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$896.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,464.00
|
| Rate for Payer: Cash Price |
$2,464.00
|
| Rate for Payer: Cash Price |
$2,464.00
|
| Rate for Payer: Cigna of CA HMO |
$2,867.20
|
| Rate for Payer: Cigna of CA PPO |
$3,315.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$3,808.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,688.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,988.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,075.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$3,584.00
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$2,912.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,808.00
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,688.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,240.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,240.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,240.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,240.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Cash Price |
$264.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: EPIC Health Plan Senior |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$297.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$384.80
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
OP
|
$481.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.46 |
| Max. Negotiated Rate |
$408.85 |
| Rate for Payer: Adventist Health Commercial |
$96.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$315.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.09
|
| Rate for Payer: Blue Shield of California Commercial |
$294.37
|
| Rate for Payer: Blue Shield of California EPN |
$194.32
|
| Rate for Payer: Cash Price |
$264.55
|
| Rate for Payer: Cash Price |
$264.55
|
| Rate for Payer: Cigna of CA HMO |
$307.84
|
| Rate for Payer: Cigna of CA PPO |
$355.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$384.80
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$288.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$288.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
OP
|
$6,017.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,309.35
|
| Rate for Payer: Cash Price |
$3,309.35
|
| Rate for Payer: Cash Price |
$3,309.35
|
| Rate for Payer: Cigna of CA HMO |
$3,850.88
|
| Rate for Payer: Cigna of CA PPO |
$4,452.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$5,114.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,610.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,013.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,444.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,813.60
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,911.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,114.45
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,008.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,008.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,008.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,008.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC EYE PARACENTESIS W/RELEASE AQU
|
Facility
|
IP
|
$6,017.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501304
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,203.40 |
| Max. Negotiated Rate |
$5,114.45 |
| Rate for Payer: Adventist Health Commercial |
$1,203.40
|
| Rate for Payer: Cash Price |
$3,309.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,406.80
|
| Rate for Payer: Galaxy Health WC |
$5,114.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,013.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,724.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,444.08
|
| Rate for Payer: Multiplan Commercial |
$4,813.60
|
| Rate for Payer: Networks By Design Commercial |
$3,911.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,114.45
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
IP
|
$7,266.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,453.20 |
| Max. Negotiated Rate |
$6,176.10 |
| Rate for Payer: Adventist Health Commercial |
$1,453.20
|
| Rate for Payer: Cash Price |
$3,996.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,906.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,906.40
|
| Rate for Payer: Galaxy Health WC |
$6,176.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,359.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,846.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,768.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,497.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,743.84
|
| Rate for Payer: Multiplan Commercial |
$5,812.80
|
| Rate for Payer: Networks By Design Commercial |
$4,722.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,176.10
|
|
|
HC EYE PARACENTESIS W/RML VITREOU
|
Facility
|
OP
|
$7,266.00
|
|
|
Service Code
|
CPT 65810
|
| Hospital Charge Code |
900501528
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$640.87 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,453.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,996.30
|
| Rate for Payer: Cash Price |
$3,996.30
|
| Rate for Payer: Cash Price |
$3,996.30
|
| Rate for Payer: Cigna of CA HMO |
$4,650.24
|
| Rate for Payer: Cigna of CA PPO |
$5,376.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$6,176.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,359.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,846.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,743.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$5,812.80
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$4,722.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,176.10
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,359.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,633.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
OP
|
$246.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna of CA HMO |
$157.44
|
| Rate for Payer: Cigna of CA PPO |
$182.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.01
|
| Rate for Payer: EPIC Health Plan Senior |
$31.12
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$51.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$31.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Multiplan WC |
$49.59
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
| Rate for Payer: Prime Health Services WC |
$49.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.00
|
| Rate for Payer: United Healthcare All Other HMO |
$123.00
|
| Rate for Payer: United Healthcare HMO Rider |
$123.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$31.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.23
|
| Rate for Payer: Vantage Medical Group Senior |
$31.12
|
|
|
HC EYE SERVICE ORPROCEDURE
|
Facility
|
IP
|
$246.00
|
|
|
Service Code
|
CPT 92499
|
| Hospital Charge Code |
900501542
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$49.20 |
| Max. Negotiated Rate |
$209.10 |
| Rate for Payer: Adventist Health Commercial |
$49.20
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.40
|
| Rate for Payer: EPIC Health Plan Senior |
$98.40
|
| Rate for Payer: Galaxy Health WC |
$209.10
|
| Rate for Payer: Global Benefits Group Commercial |
$147.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.04
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: Networks By Design Commercial |
$159.90
|
| Rate for Payer: Prime Health Services Commercial |
$209.10
|
|
|
HC FAC DIR VEN LYMPHANGIOMATOSIS MAL THER
|
Facility
|
IP
|
$23,534.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811799
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,706.80 |
| Max. Negotiated Rate |
$20,003.90 |
| Rate for Payer: Adventist Health Commercial |
$4,706.80
|
| Rate for Payer: Cash Price |
$12,943.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,413.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9,413.60
|
| Rate for Payer: Galaxy Health WC |
$20,003.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,120.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,697.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,966.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,567.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,648.16
|
| Rate for Payer: Multiplan Commercial |
$18,827.20
|
| Rate for Payer: Networks By Design Commercial |
$15,297.10
|
| Rate for Payer: Prime Health Services Commercial |
$20,003.90
|
|
|
HC FAC DIR VEN LYMPHANGIOMATOSIS MAL THER
|
Facility
|
OP
|
$23,534.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
906811799
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$785.56 |
| Max. Negotiated Rate |
$20,003.90 |
| Rate for Payer: Adventist Health Commercial |
$4,706.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,452.23
|
| 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 |
$12,943.70
|
| Rate for Payer: Cash Price |
$12,943.70
|
| Rate for Payer: Cash Price |
$12,943.70
|
| Rate for Payer: Cigna of CA HMO |
$15,061.76
|
| Rate for Payer: Cigna of CA PPO |
$17,415.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$20,003.90
|
| Rate for Payer: Global Benefits Group Commercial |
$14,120.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,697.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,648.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$18,827.20
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$15,297.10
|
| Rate for Payer: Prime Health Services Commercial |
$20,003.90
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,120.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.60 |
| Max. Negotiated Rate |
$1,014.05 |
| Rate for Payer: Adventist Health Commercial |
$238.60
|
| Rate for Payer: Cash Price |
$656.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$477.20
|
| Rate for Payer: EPIC Health Plan Senior |
$477.20
|
| Rate for Payer: Galaxy Health WC |
$1,014.05
|
| Rate for Payer: Global Benefits Group Commercial |
$715.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$454.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$738.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.32
|
| Rate for Payer: Multiplan Commercial |
$954.40
|
| Rate for Payer: Networks By Design Commercial |
$775.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.05
|
|
|
HC FACIAL BONES COMPLETE
|
Facility
|
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
909001101
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.63 |
| Max. Negotiated Rate |
$1,014.05 |
| Rate for Payer: Adventist Health Commercial |
$238.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$782.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.43
|
| Rate for Payer: Blue Shield of California Commercial |
$730.12
|
| Rate for Payer: Blue Shield of California EPN |
$481.97
|
| Rate for Payer: Cash Price |
$656.15
|
| Rate for Payer: Cash Price |
$656.15
|
| Rate for Payer: Cigna of CA HMO |
$763.52
|
| Rate for Payer: Cigna of CA PPO |
$882.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,014.05
|
| Rate for Payer: Global Benefits Group Commercial |
$715.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$62.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$795.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$954.40
|
| Rate for Payer: Networks By Design Commercial |
$775.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,014.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$715.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$715.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.20 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$318.40
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$303.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$492.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
|
|
HC FACIAL BONES LIMITED
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
909001102
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$676.60 |
| Rate for Payer: Adventist Health Commercial |
$159.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$522.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.95
|
| Rate for Payer: Blue Shield of California Commercial |
$487.15
|
| Rate for Payer: Blue Shield of California EPN |
$321.58
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cash Price |
$437.80
|
| Rate for Payer: Cigna of CA HMO |
$509.44
|
| Rate for Payer: Cigna of CA PPO |
$589.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$676.60
|
| Rate for Payer: Global Benefits Group Commercial |
$477.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$530.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$191.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Networks By Design Commercial |
$517.40
|
| Rate for Payer: Prime Health Services Commercial |
$676.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$477.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$477.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC FACTOR II (2) ASSAY
|
Facility
|
OP
|
$527.00
|
|
|
Service Code
|
CPT 85210
|
| Hospital Charge Code |
900910075
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$447.95 |
| Rate for Payer: Adventist Health Commercial |
$105.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$345.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.27
|
| Rate for Payer: Blue Shield of California Commercial |
$352.56
|
| Rate for Payer: Blue Shield of California EPN |
$232.93
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Cash Price |
$289.85
|
| Rate for Payer: Cigna of CA HMO |
$337.28
|
| Rate for Payer: Cigna of CA PPO |
$389.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.52
|
| Rate for Payer: EPIC Health Plan Senior |
$12.98
|
| Rate for Payer: Galaxy Health WC |
$447.95
|
| Rate for Payer: Global Benefits Group Commercial |
$316.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$351.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Networks By Design Commercial |
$342.55
|
| Rate for Payer: Prime Health Services Commercial |
$447.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.51
|
| Rate for Payer: United Healthcare All Other HMO |
$10.51
|
| Rate for Payer: United Healthcare HMO Rider |
$10.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.51
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.28
|
| Rate for Payer: Vantage Medical Group Senior |
$12.98
|
|
