|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$99.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.34
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC I.D. PENTAGASTRIN CONCENTRATIO
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
909301533
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Blue Shield of California Commercial |
$112.18
|
| Rate for Payer: Blue Shield of California EPN |
$73.87
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.48
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
OP
|
$2,406.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$151.37 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$481.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: Cigna of CA HMO |
$1,539.84
|
| Rate for Payer: Cigna of CA PPO |
$1,780.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$2,045.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,443.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,604.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$1,924.80
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$1,563.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,045.10
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,443.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,203.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC I&D PERIANAL ABSCESS SUPERFICIAL
|
Facility
|
IP
|
$2,406.00
|
|
|
Service Code
|
CPT 46050
|
| Hospital Charge Code |
900501156
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$481.20 |
| Max. Negotiated Rate |
$2,045.10 |
| Rate for Payer: Adventist Health Commercial |
$481.20
|
| Rate for Payer: Cash Price |
$1,323.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$962.40
|
| Rate for Payer: EPIC Health Plan Senior |
$962.40
|
| Rate for Payer: Galaxy Health WC |
$2,045.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,443.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,604.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$916.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,489.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.44
|
| Rate for Payer: Multiplan Commercial |
$1,924.80
|
| Rate for Payer: Networks By Design Commercial |
$1,563.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,045.10
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
OP
|
$1,148.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$138.64 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$631.40
|
| Rate for Payer: Cash Price |
$631.40
|
| Rate for Payer: Cash Price |
$631.40
|
| Rate for Payer: Cigna of CA HMO |
$734.72
|
| Rate for Payer: Cigna of CA PPO |
$849.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$975.80
|
| Rate for Payer: Global Benefits Group Commercial |
$688.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$765.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$975.80
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$688.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.00
|
| Rate for Payer: United Healthcare All Other HMO |
$574.00
|
| Rate for Payer: United Healthcare HMO Rider |
$574.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$574.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC I&D PERITONSILAR ABSCESS
|
Facility
|
IP
|
$1,148.00
|
|
|
Service Code
|
CPT 42700
|
| Hospital Charge Code |
900501151
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$975.80 |
| Rate for Payer: Adventist Health Commercial |
$229.60
|
| Rate for Payer: Cash Price |
$631.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.20
|
| Rate for Payer: EPIC Health Plan Senior |
$459.20
|
| Rate for Payer: Galaxy Health WC |
$975.80
|
| Rate for Payer: Global Benefits Group Commercial |
$688.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$765.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$710.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.52
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: Networks By Design Commercial |
$746.20
|
| Rate for Payer: Prime Health Services Commercial |
$975.80
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
IP
|
$4,371.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$874.20 |
| Max. Negotiated Rate |
$3,715.35 |
| Rate for Payer: Adventist Health Commercial |
$874.20
|
| Rate for Payer: Cash Price |
$2,404.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.40
|
| Rate for Payer: Galaxy Health WC |
$3,715.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,915.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,665.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,705.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.04
|
| Rate for Payer: Multiplan Commercial |
$3,496.80
|
| Rate for Payer: Networks By Design Commercial |
$2,841.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,715.35
|
|
|
HC I & D PILONIDAL CYST COMPLICAT
|
Facility
|
OP
|
$4,371.00
|
|
|
Service Code
|
CPT 10081
|
| Hospital Charge Code |
900501530
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.51 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$874.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,404.05
|
| Rate for Payer: Cash Price |
$2,404.05
|
| Rate for Payer: Cash Price |
$2,404.05
|
| Rate for Payer: Cigna of CA HMO |
$2,797.44
|
| Rate for Payer: Cigna of CA PPO |
$3,234.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$3,715.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,915.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$219.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,049.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$3,496.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,841.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,715.35
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,622.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,185.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,185.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,185.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,185.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
OP
|
$1,071.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$214.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cigna of CA HMO |
$685.44
|
| Rate for Payer: Cigna of CA PPO |
$792.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$714.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$856.80
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$642.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$535.50
|
| Rate for Payer: United Healthcare All Other HMO |
$535.50
|
| Rate for Payer: United Healthcare HMO Rider |
$535.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$535.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC I & D PILONIDAL CYST SIMPLE
|
Facility
|
IP
|
$1,071.00
|
|
|
Service Code
|
CPT 10080
|
| Hospital Charge Code |
900501002
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$214.20 |
| Max. Negotiated Rate |
$910.35 |
| Rate for Payer: Adventist Health Commercial |
$214.20
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$428.40
|
| Rate for Payer: Galaxy Health WC |
$910.35
|
| Rate for Payer: Global Benefits Group Commercial |
$642.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$714.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$408.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$662.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$257.04
|
| Rate for Payer: Multiplan Commercial |
$856.80
|
| Rate for Payer: Networks By Design Commercial |
$696.15
|
| Rate for Payer: Prime Health Services Commercial |
$910.35
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
|
OP
|
$5,173.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,034.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,397.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,845.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,879.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$2,845.15
|
| Rate for Payer: Cash Price |
$2,845.15
|
| Rate for Payer: Cigna of CA HMO |
$3,310.72
|
| Rate for Payer: Cigna of CA PPO |
$3,828.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,397.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,397.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,397.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,069.20
|
| Rate for Payer: Galaxy Health WC |
$4,397.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,103.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,450.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,970.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,202.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,621.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,621.10
|
| Rate for Payer: Multiplan Commercial |
$4,138.40
|
| Rate for Payer: Networks By Design Commercial |
$3,362.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,397.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,103.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,397.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,397.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4,397.05
|
|
|
HC IDR CORDIS VISTA BRITE TIPN
|
Facility
|
IP
|
$5,173.00
|
|
|
Service Code
|
CPT 0220T
|
| Hospital Charge Code |
909010220
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,034.60 |
| Max. Negotiated Rate |
$4,397.05 |
| Rate for Payer: Adventist Health Commercial |
$1,034.60
|
| Rate for Payer: Cash Price |
$2,845.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,069.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,069.20
|
| Rate for Payer: Galaxy Health WC |
$4,397.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,103.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,450.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,970.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,202.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,241.52
|
| Rate for Payer: Multiplan Commercial |
$4,138.40
|
| Rate for Payer: Networks By Design Commercial |
$3,362.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,397.05
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
IP
|
$10,248.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,049.60 |
| Max. Negotiated Rate |
$8,710.80 |
| Rate for Payer: Adventist Health Commercial |
$2,049.60
|
| Rate for Payer: Cash Price |
$5,636.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,099.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,099.20
|
| Rate for Payer: Galaxy Health WC |
$8,710.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,148.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,904.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,343.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.52
|
| Rate for Payer: Multiplan Commercial |
$8,198.40
|
| Rate for Payer: Networks By Design Commercial |
$6,661.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,710.80
|
|
|
HC I&D RECTAL ABSCESS
|
Facility
|
OP
|
$10,248.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
900501335
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$339.53 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$2,049.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,636.40
|
| Rate for Payer: Cash Price |
$5,636.40
|
| Rate for Payer: Cash Price |
$5,636.40
|
| Rate for Payer: Cigna of CA HMO |
$6,558.72
|
| Rate for Payer: Cigna of CA PPO |
$7,583.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$8,710.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,148.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,835.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,459.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$8,198.40
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$6,661.20
|
| Rate for Payer: Prime Health Services Commercial |
$8,710.80
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,148.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,124.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,124.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,124.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,124.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
|
IP
|
$3,465.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.00 |
| Max. Negotiated Rate |
$2,945.25 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Cash Price |
$1,905.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,386.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,386.00
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,311.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,320.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,144.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
|
|
HC I & D THYROGLOSSAL DUCT CYST
|
Facility
|
OP
|
$3,465.00
|
|
|
Service Code
|
CPT 60000
|
| Hospital Charge Code |
900501674
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$128.74 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$693.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,905.75
|
| Rate for Payer: Cash Price |
$1,905.75
|
| Rate for Payer: Cash Price |
$1,905.75
|
| Rate for Payer: Cigna of CA HMO |
$2,217.60
|
| Rate for Payer: Cigna of CA PPO |
$2,564.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$2,945.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,079.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,311.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$831.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$2,772.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,252.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,945.25
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,079.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,732.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,732.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,732.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,732.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
IP
|
$5,049.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,009.80 |
| Max. Negotiated Rate |
$4,291.65 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,019.60
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,125.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.76
|
| Rate for Payer: Multiplan Commercial |
$4,039.20
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
OP
|
$5,049.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Cigna of CA HMO |
$3,231.36
|
| Rate for Payer: Cigna of CA PPO |
$3,736.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$4,039.20
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,029.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,029.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
IP
|
$5,049.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,009.80 |
| Max. Negotiated Rate |
$4,291.65 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,019.60
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,125.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.76
|
| Rate for Payer: Multiplan Commercial |
$4,039.20
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
OP
|
$5,049.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Cash Price |
$2,776.95
|
| Rate for Payer: Cigna of CA HMO |
$3,231.36
|
| Rate for Payer: Cigna of CA PPO |
$3,736.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$4,039.20
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,029.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,524.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,524.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,524.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,524.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC IHC EACH ADDL SINGLE MULTI PER SPEC MEDI
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800243
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$432.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$738.05
|
| Rate for Payer: Blue Shield of California Commercial |
$441.54
|
| Rate for Payer: Blue Shield of California EPN |
$291.72
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna of CA HMO |
$422.40
|
| Rate for Payer: Cigna of CA PPO |
$488.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$440.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$396.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$396.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC IHC EACH ADDL SINGLE MULTI PER SPEC MEDI
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800243
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Senior |
$264.00
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$440.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$408.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
|
|
HC IHC FIRST SINGLE MULTI PER SPEC MEDI
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800242
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Cash Price |
$293.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Senior |
$213.60
|
| Rate for Payer: Galaxy Health WC |
$453.90
|
| Rate for Payer: Global Benefits Group Commercial |
$320.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$330.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.16
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Networks By Design Commercial |
$347.10
|
| Rate for Payer: Prime Health Services Commercial |
$453.90
|
|
|
HC IHC FIRST SINGLE MULTI PER SPEC MEDI
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800242
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.37 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.16
|
| Rate for Payer: Blue Shield of California Commercial |
$357.25
|
| Rate for Payer: Blue Shield of California EPN |
$236.03
|
| Rate for Payer: Cash Price |
$293.70
|
| Rate for Payer: Cash Price |
$293.70
|
| Rate for Payer: Cigna of CA HMO |
$341.76
|
| Rate for Payer: Cigna of CA PPO |
$395.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$453.90
|
| Rate for Payer: Global Benefits Group Commercial |
$320.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Networks By Design Commercial |
$347.10
|
| Rate for Payer: Prime Health Services Commercial |
$453.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$320.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$320.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
OP
|
$3,280.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820131
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$92.90 |
| Max. Negotiated Rate |
$2,788.00 |
| Rate for Payer: Adventist Health Commercial |
$656.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,151.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,788.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,804.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,460.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,007.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,325.12
|
| Rate for Payer: Cash Price |
$1,804.00
|
| Rate for Payer: Cash Price |
$1,804.00
|
| Rate for Payer: Cigna of CA HMO |
$2,099.20
|
| Rate for Payer: Cigna of CA PPO |
$2,427.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,788.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,788.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,788.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,312.00
|
| Rate for Payer: Galaxy Health WC |
$2,788.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,968.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,249.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,030.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,296.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,296.00
|
| Rate for Payer: Multiplan Commercial |
$2,624.00
|
| Rate for Payer: Networks By Design Commercial |
$2,132.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,788.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,968.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,968.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,640.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,640.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,640.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,640.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,788.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,788.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,788.00
|
|
