|
HC INTRACAVITARY INTER
|
Facility
|
OP
|
$36,195.00
|
|
|
Service Code
|
CPT 77762
|
| Hospital Charge Code |
909100402
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$718.07 |
| Max. Negotiated Rate |
$30,765.75 |
| Rate for Payer: Adventist Health Commercial |
$7,239.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23,740.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,043.54
|
| Rate for Payer: Blue Shield of California Commercial |
$22,151.34
|
| Rate for Payer: Blue Shield of California EPN |
$14,622.78
|
| Rate for Payer: Cash Price |
$16,287.75
|
| Rate for Payer: Cash Price |
$16,287.75
|
| Rate for Payer: Cigna of CA HMO |
$23,164.80
|
| Rate for Payer: Cigna of CA PPO |
$26,784.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$30,765.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21,717.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$718.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,142.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$812.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,686.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$28,956.00
|
| Rate for Payer: Networks By Design Commercial |
$23,526.75
|
| Rate for Payer: Prime Health Services Commercial |
$30,765.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,717.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21,717.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,097.50
|
| Rate for Payer: United Healthcare All Other HMO |
$18,097.50
|
| Rate for Payer: United Healthcare HMO Rider |
$18,097.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,097.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC INTRACAVITARY SIMPLE
|
Facility
|
IP
|
$34,472.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
909100401
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$6,894.40 |
| Max. Negotiated Rate |
$29,301.20 |
| Rate for Payer: Adventist Health Commercial |
$6,894.40
|
| Rate for Payer: Cash Price |
$15,512.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,788.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13,788.80
|
| Rate for Payer: Galaxy Health WC |
$29,301.20
|
| Rate for Payer: Global Benefits Group Commercial |
$20,683.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,992.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,133.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,338.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,273.28
|
| Rate for Payer: Multiplan Commercial |
$27,577.60
|
| Rate for Payer: Networks By Design Commercial |
$22,406.80
|
| Rate for Payer: Prime Health Services Commercial |
$29,301.20
|
|
|
HC INTRACAVITARY SIMPLE
|
Facility
|
OP
|
$34,472.00
|
|
|
Service Code
|
CPT 77761
|
| Hospital Charge Code |
909100401
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$541.77 |
| Max. Negotiated Rate |
$29,301.20 |
| Rate for Payer: Adventist Health Commercial |
$6,894.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22,610.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$726.81
|
| Rate for Payer: Blue Shield of California Commercial |
$21,096.86
|
| Rate for Payer: Blue Shield of California EPN |
$13,926.69
|
| Rate for Payer: Cash Price |
$15,512.40
|
| Rate for Payer: Cash Price |
$15,512.40
|
| Rate for Payer: Cigna of CA HMO |
$22,062.08
|
| Rate for Payer: Cigna of CA PPO |
$25,509.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$808.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$735.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$992.25
|
| Rate for Payer: EPIC Health Plan Senior |
$735.00
|
| Rate for Payer: Galaxy Health WC |
$29,301.20
|
| Rate for Payer: Global Benefits Group Commercial |
$20,683.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,205.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$541.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$735.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,992.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$612.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,273.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$926.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$984.90
|
| Rate for Payer: Multiplan Commercial |
$27,577.60
|
| Rate for Payer: Networks By Design Commercial |
$22,406.80
|
| Rate for Payer: Prime Health Services Commercial |
$29,301.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,683.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20,683.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,236.00
|
| Rate for Payer: United Healthcare All Other HMO |
$17,236.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,236.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17,236.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$735.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$808.50
|
| Rate for Payer: Vantage Medical Group Senior |
$735.00
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$809.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,104.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: Cigna of CA HMO |
$942.08
|
| Rate for Payer: Cigna of CA PPO |
$1,089.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,251.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,030.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,030.40
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$883.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,251.20
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
906820229
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$294.40 |
| Max. Negotiated Rate |
$1,251.20 |
| Rate for Payer: Adventist Health Commercial |
$294.40
|
| Rate for Payer: Cash Price |
$662.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$588.80
|
| Rate for Payer: EPIC Health Plan Senior |
$588.80
|
| Rate for Payer: Galaxy Health WC |
$1,251.20
|
| Rate for Payer: Global Benefits Group Commercial |
$883.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$981.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$560.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$911.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.28
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: Networks By Design Commercial |
$956.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,251.20
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
OP
|
$1,088.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Cigna of CA HMO |
$696.32
|
| Rate for Payer: Cigna of CA PPO |
$805.12
|
| Rate for Payer: Adventist Health Commercial |
$217.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$924.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$598.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$816.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$924.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$924.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$924.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.20
|
| Rate for Payer: EPIC Health Plan Senior |
$435.20
|
| Rate for Payer: Galaxy Health WC |
$924.80
|
| Rate for Payer: Global Benefits Group Commercial |
$652.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$344.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$673.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$761.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$761.60
|
| Rate for Payer: Multiplan Commercial |
$870.40
|
| Rate for Payer: Networks By Design Commercial |
$707.20
|
| Rate for Payer: Prime Health Services Commercial |
$924.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$652.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$924.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$924.80
|
| Rate for Payer: Vantage Medical Group Senior |
$924.80
|
|
|
HC INTRACRAN CAROTID/VERT
|
Facility
|
IP
|
$1,088.00
|
|
|
Service Code
|
CPT 36228
|
| Hospital Charge Code |
909020161
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.60 |
| Max. Negotiated Rate |
$924.80 |
| Rate for Payer: Adventist Health Commercial |
$217.60
|
| Rate for Payer: Cash Price |
$489.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$435.20
|
| Rate for Payer: EPIC Health Plan Senior |
$435.20
|
| Rate for Payer: Galaxy Health WC |
$924.80
|
| Rate for Payer: Global Benefits Group Commercial |
$652.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$725.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$414.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$673.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$261.12
|
| Rate for Payer: Multiplan Commercial |
$870.40
|
| Rate for Payer: Networks By Design Commercial |
$707.20
|
| Rate for Payer: Prime Health Services Commercial |
$924.80
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
OP
|
$11,276.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,112.70 |
| Max. Negotiated Rate |
$13,494.00 |
| Rate for Payer: Adventist Health Commercial |
$2,255.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,494.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,584.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,201.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,457.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,074.20
|
| Rate for Payer: Cash Price |
$5,074.20
|
| Rate for Payer: Cash Price |
$5,074.20
|
| Rate for Payer: Cigna of CA HMO |
$7,216.64
|
| Rate for Payer: Cigna of CA PPO |
$8,344.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,584.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,584.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,584.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,510.40
|
| Rate for Payer: Galaxy Health WC |
$9,584.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,765.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,112.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,979.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,706.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,893.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,893.20
|
| Rate for Payer: Multiplan Commercial |
$9,020.80
|
| Rate for Payer: Networks By Design Commercial |
$7,329.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,584.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,765.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,584.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,584.60
|
| Rate for Payer: Vantage Medical Group Senior |
$9,584.60
|
|
|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
IP
|
$11,276.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,255.20 |
| Max. Negotiated Rate |
$9,584.60 |
| Rate for Payer: Adventist Health Commercial |
$2,255.20
|
| Rate for Payer: Cash Price |
$5,074.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,510.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,510.40
|
| Rate for Payer: Galaxy Health WC |
$9,584.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,765.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,521.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,296.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,979.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,706.24
|
| Rate for Payer: Multiplan Commercial |
$9,020.80
|
| Rate for Payer: Networks By Design Commercial |
$7,329.40
|
| Rate for Payer: Prime Health Services Commercial |
$9,584.60
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
IP
|
$3,582.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$716.40 |
| Max. Negotiated Rate |
$3,044.70 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,432.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,432.80
|
| Rate for Payer: Galaxy Health WC |
$3,044.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,149.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,389.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,364.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,217.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.68
|
| Rate for Payer: Multiplan Commercial |
$2,865.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,044.70
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
OP
|
$3,582.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$716.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,044.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,970.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,686.50
|
| 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 |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cash Price |
$1,611.90
|
| Rate for Payer: Cigna of CA HMO |
$2,292.48
|
| Rate for Payer: Cigna of CA PPO |
$2,650.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,044.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,044.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,044.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,432.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,432.80
|
| Rate for Payer: Galaxy Health WC |
$3,044.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,149.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$746.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,389.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,217.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$859.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,507.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,507.40
|
| Rate for Payer: Multiplan Commercial |
$2,865.60
|
| Rate for Payer: Networks By Design Commercial |
$2,328.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,044.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,149.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,044.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,044.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,044.70
|
|
|
HC INTRANASAL BX
|
Facility
|
OP
|
$3,083.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: Cigna of CA HMO |
$1,973.12
|
| Rate for Payer: Cigna of CA PPO |
$2,281.42
|
| 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 |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,056.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.92
|
| 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 |
$2,466.40
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,849.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| 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 INTRANASAL BX
|
Facility
|
IP
|
$3,083.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$616.60 |
| Max. Negotiated Rate |
$2,620.55 |
| Rate for Payer: Adventist Health Commercial |
$616.60
|
| Rate for Payer: Cash Price |
$1,387.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,233.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,233.20
|
| Rate for Payer: Galaxy Health WC |
$2,620.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,849.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,056.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,174.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,908.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$739.92
|
| Rate for Payer: Multiplan Commercial |
$2,466.40
|
| Rate for Payer: Networks By Design Commercial |
$2,003.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,620.55
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
IP
|
$10,363.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,072.60 |
| Max. Negotiated Rate |
$8,808.55 |
| Rate for Payer: Adventist Health Commercial |
$2,072.60
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,145.20
|
| Rate for Payer: Galaxy Health WC |
$8,808.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,217.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,948.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,414.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,487.12
|
| Rate for Payer: Multiplan Commercial |
$8,290.40
|
| Rate for Payer: Networks By Design Commercial |
$6,735.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,808.55
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
OP
|
$10,363.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$8,808.55 |
| Rate for Payer: Adventist Health Commercial |
$2,072.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,797.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8,808.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,699.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,772.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: Cigna of CA HMO |
$6,632.32
|
| Rate for Payer: Cigna of CA PPO |
$7,668.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8,808.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,808.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,808.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,145.20
|
| Rate for Payer: Galaxy Health WC |
$8,808.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,217.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$943.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,067.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,414.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,487.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,254.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,254.10
|
| Rate for Payer: Multiplan Commercial |
$8,290.40
|
| Rate for Payer: Networks By Design Commercial |
$6,735.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,808.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,217.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,217.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8,808.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,808.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8,808.55
|
|
|
HC INTRAOP NEURO TESTING, EA 15 MIN
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$296.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$481.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
|
|
HC INTRAOP NEURO TESTING, EA 15 MIN
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$45.44 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$510.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$427.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$583.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$477.77
|
| Rate for Payer: Blue Shield of California Commercial |
$476.14
|
| Rate for Payer: Blue Shield of California EPN |
$314.31
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna of CA HMO |
$497.92
|
| Rate for Payer: Cigna of CA PPO |
$575.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$661.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$661.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$661.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$45.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$518.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$481.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$544.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$544.60
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$661.30
|
| Rate for Payer: Vantage Medical Group Senior |
$661.30
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
IP
|
$8,440.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,688.00 |
| Max. Negotiated Rate |
$7,174.00 |
| Rate for Payer: Adventist Health Commercial |
$1,688.00
|
| Rate for Payer: Cash Price |
$3,798.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,376.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,376.00
|
| Rate for Payer: Galaxy Health WC |
$7,174.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,064.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,629.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,215.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,224.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,025.60
|
| Rate for Payer: Multiplan Commercial |
$6,752.00
|
| Rate for Payer: Networks By Design Commercial |
$5,486.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,174.00
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
OP
|
$8,440.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$415.93 |
| Max. Negotiated Rate |
$7,174.00 |
| Rate for Payer: Adventist Health Commercial |
$1,688.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,798.00
|
| Rate for Payer: Cash Price |
$3,798.00
|
| Rate for Payer: Cash Price |
$3,798.00
|
| Rate for Payer: Cigna of CA HMO |
$5,401.60
|
| Rate for Payer: Cigna of CA PPO |
$6,245.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$7,174.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,064.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,629.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,025.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$6,752.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$5,486.00
|
| Rate for Payer: Prime Health Services Commercial |
$7,174.00
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,064.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,220.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,220.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,220.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,220.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
IP
|
$6,548.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,309.60 |
| Max. Negotiated Rate |
$5,565.80 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,619.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,619.20
|
| Rate for Payer: Galaxy Health WC |
$5,565.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,928.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,494.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,053.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| Rate for Payer: Multiplan Commercial |
$5,238.40
|
| Rate for Payer: Networks By Design Commercial |
$4,256.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,565.80
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
OP
|
$6,548.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$398.96 |
| Max. Negotiated Rate |
$5,565.80 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| 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 |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cash Price |
$2,946.60
|
| Rate for Payer: Cigna of CA HMO |
$4,190.72
|
| Rate for Payer: Cigna of CA PPO |
$4,845.52
|
| 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 |
$5,565.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,928.80
|
| 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 |
$4,367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| 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 |
$5,238.40
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$4,256.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,565.80
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,928.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,274.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,274.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,274.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,274.00
|
| 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 INTRAORAL INCISION OF ABSCESS
|
Facility
|
IP
|
$5,987.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,197.40 |
| Max. Negotiated Rate |
$5,088.95 |
| Rate for Payer: Adventist Health Commercial |
$1,197.40
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,394.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,394.80
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,993.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,281.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,705.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Multiplan Commercial |
$4,789.60
|
| Rate for Payer: Networks By Design Commercial |
$3,891.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,088.95
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
OP
|
$5,987.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,197.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cash Price |
$2,694.15
|
| Rate for Payer: Cigna of CA HMO |
$3,831.68
|
| Rate for Payer: Cigna of CA PPO |
$4,430.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,993.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$4,789.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$3,891.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,088.95
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,592.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,993.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,993.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,993.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,993.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$1,731.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$346.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$778.95
|
| Rate for Payer: Cash Price |
$778.95
|
| Rate for Payer: Cash Price |
$778.95
|
| Rate for Payer: Cigna of CA HMO |
$1,107.84
|
| Rate for Payer: Cigna of CA PPO |
$1,280.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,471.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,154.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$1,384.80
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$1,125.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,471.35
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,038.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$865.50
|
| Rate for Payer: United Healthcare All Other HMO |
$865.50
|
| Rate for Payer: United Healthcare HMO Rider |
$865.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$865.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$1,731.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$346.20 |
| Max. Negotiated Rate |
$1,471.35 |
| Rate for Payer: Adventist Health Commercial |
$346.20
|
| Rate for Payer: Cash Price |
$778.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$692.40
|
| Rate for Payer: EPIC Health Plan Senior |
$692.40
|
| Rate for Payer: Galaxy Health WC |
$1,471.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,038.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,154.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$659.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,071.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.44
|
| Rate for Payer: Multiplan Commercial |
$1,384.80
|
| Rate for Payer: Networks By Design Commercial |
$1,125.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,471.35
|
|
