|
HC EXPLORATION OF NECK WOUND
|
Facility
|
IP
|
$2,129.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.80 |
| Max. Negotiated Rate |
$1,809.65 |
| Rate for Payer: Adventist Health Commercial |
$425.80
|
| Rate for Payer: Cash Price |
$958.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$851.60
|
| Rate for Payer: EPIC Health Plan Senior |
$851.60
|
| Rate for Payer: Galaxy Health WC |
$1,809.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,277.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,351.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.96
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: Networks By Design Commercial |
$1,383.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,809.65
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
OP
|
$2,129.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$425.80 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$425.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$958.05
|
| Rate for Payer: Cash Price |
$958.05
|
| Rate for Payer: Cash Price |
$958.05
|
| Rate for Payer: Cigna of CA HMO |
$1,362.56
|
| Rate for Payer: Cigna of CA PPO |
$1,575.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$1,809.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,277.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,351.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,383.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,809.65
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,277.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,064.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,064.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,064.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,064.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
IP
|
$2,129.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$425.80 |
| Max. Negotiated Rate |
$1,809.65 |
| Rate for Payer: Adventist Health Commercial |
$425.80
|
| Rate for Payer: Cash Price |
$958.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$851.60
|
| Rate for Payer: EPIC Health Plan Senior |
$851.60
|
| Rate for Payer: Galaxy Health WC |
$1,809.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,277.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,351.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,256.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.96
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: Networks By Design Commercial |
$1,383.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,809.65
|
|
|
HC EXPLORATION OF NECK WOUND
|
Facility
|
OP
|
$2,129.00
|
|
|
Service Code
|
CPT 20100
|
| Hospital Charge Code |
900501384
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$440.00 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Adventist Health Commercial |
$872.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,706.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$958.05
|
| Rate for Payer: Cash Price |
$958.05
|
| Rate for Payer: Cash Price |
$958.05
|
| Rate for Payer: Cigna of CA HMO |
$1,362.56
|
| Rate for Payer: Cigna of CA PPO |
$1,575.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$1,809.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,277.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,351.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$664.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,703.20
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,383.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,809.65
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,277.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,277.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
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 |
$5,418.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,428.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,645.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,103.60
|
| 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 KNEE I & D W/F.B. RMVL
|
Facility
|
OP
|
$12,040.00
|
|
|
Service Code
|
CPT 27310
|
| Hospital Charge Code |
900501671
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$961.32 |
| Max. Negotiated Rate |
$10,234.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Adventist Health Commercial |
$2,408.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$5,418.00
|
| Rate for Payer: Cash Price |
$5,418.00
|
| Rate for Payer: Cash Price |
$5,418.00
|
| Rate for Payer: Cigna of CA HMO |
$7,705.60
|
| Rate for Payer: Cigna of CA PPO |
$8,909.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,428.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$10,234.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,224.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,645.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$961.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,889.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$9,632.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$7,826.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,234.00
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,224.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,020.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,020.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,020.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,020.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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 |
$2,730.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,246.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,852.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,579.53
|
| 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 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,213.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,730.15
|
| Rate for Payer: Cash Price |
$2,730.15
|
| Rate for Payer: Cash Price |
$2,730.15
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,246.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| 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/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,852.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,365.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,456.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
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 |
$2,553.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,972.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,603.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,348.25
|
| 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 |
$9,104.00 |
| Rate for Payer: Adventist Health Commercial |
$1,135.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Cash Price |
$2,553.75
|
| Rate for Payer: Cash Price |
$2,553.75
|
| Rate for Payer: Cash Price |
$2,553.75
|
| 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 |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,972.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| 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/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,603.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$446.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,362.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,302.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,639.18
|
| 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 |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
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 |
$3,132.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,872.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,420.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,106.99
|
| 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 |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,392.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Cash Price |
$3,132.45
|
| Rate for Payer: Cash Price |
$3,132.45
|
| 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 |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,872.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| 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/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,420.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$884.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,670.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| 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 |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,597.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$8,094.60
|
| Rate for Payer: Cash Price |
$8,094.60
|
| Rate for Payer: Cash Price |
$8,094.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,591.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$11,422.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,612.92
|
| 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 |
$8,994.00
|
| 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 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 |
$8,094.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,591.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$11,422.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,612.92
|
| 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 ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$310.25 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$292.00
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.22
|
| Rate for Payer: Blue Shield of California Commercial |
$153.66
|
| Rate for Payer: Blue Shield of California Commercial |
$232.87
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$270.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$292.00
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.30
|
| Rate for Payer: Blue Shield of California Commercial |
$202.92
|
| Rate for Payer: Blue Shield of California Commercial |
$307.52
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$308.48
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$322.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$364.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.30
|
| Rate for Payer: Blue Shield of California Commercial |
$202.92
|
| Rate for Payer: Blue Shield of California Commercial |
$307.52
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$308.48
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.27
|
| Rate for Payer: EPIC Health Plan Senior |
$52.84
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$23.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.37
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.84
|
| Rate for Payer: Vantage Medical Group Senior |
$48.04
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$267.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.30
|
| Rate for Payer: Blue Shield of California Commercial |
$202.92
|
| Rate for Payer: Blue Shield of California Commercial |
$307.52
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cigna of CA HMO |
$308.48
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$338.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$382.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$409.70 |
| Rate for Payer: Adventist Health Commercial |
$96.40
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$337.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Senior |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$115.68
|
| Rate for Payer: Multiplan Commercial |
$385.60
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.36 |
| Max. Negotiated Rate |
$636.65 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$135.36
|
| 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 |
$480.63
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Cash Price |
$337.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$524.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$475.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$271.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$441.91
|
| 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 |
$337.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$524.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$475.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$441.91
|
| 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 |
915352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| 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
|
|
