|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,908.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,359.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,979.60
|
| 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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,908.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| 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/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,359.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,025.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| 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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
IP
|
$8,440.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,908.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,359.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,979.60
|
| 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
|
456
|
| Min. Negotiated Rate |
$415.93 |
| Max. Negotiated Rate |
$7,174.00 |
| Rate for Payer: Adventist Health Commercial |
$3,460.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,783.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,908.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| 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/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,359.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,025.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| 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: TriValley Medical Group Commercial/Senior |
$5,064.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
IP
|
$6,548.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,583.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,157.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,863.32
|
| 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
|
456
|
| Min. Negotiated Rate |
$398.96 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$2,684.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,667.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,583.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| 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/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,157.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| 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: TriValley Medical Group Commercial/Senior |
$3,928.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,309.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,583.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| 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/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,157.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$398.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,571.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| 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 |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,583.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,157.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,863.32
|
| 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 INCISION OF ABSCESS
|
Facility
|
OP
|
$5,987.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$5,641.00 |
| 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: Adventist Health Commercial |
$2,454.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$750.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,190.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,801.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$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: TriValley Medical Group Commercial/Senior |
$3,592.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,190.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,801.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,532.33
|
| 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
|
IP
|
$5,987.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,190.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,801.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,532.33
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,197.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,190.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$5,088.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,592.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,801.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,436.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$874.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$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 |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$346.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,211.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| 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/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,099.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| 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 |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$1,731.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Adventist Health Commercial |
$709.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$385.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$861.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,211.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| 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/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,099.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$415.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$723.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$769.91
|
| 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: TriValley Medical Group Commercial/Senior |
$1,038.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
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: Cash Price |
$778.95
|
| Rate for Payer: Adventist Health Commercial |
$346.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,211.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,099.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.29
|
| 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
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$1,731.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,211.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,099.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.29
|
| 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
|
|
|
HC INTRAVASC LITHO FEM AND POP VASC SAME ARTERY
|
Facility
|
OP
|
$17,142.00
|
|
|
Service Code
|
CPT 37279
|
| Hospital Charge Code |
906811845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,428.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,428.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,570.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,428.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,856.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,000.02
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Cigna of CA HMO |
$10,970.88
|
| Rate for Payer: Cigna of CA PPO |
$12,685.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,570.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,570.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,570.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,999.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,856.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,856.80
|
| Rate for Payer: Galaxy Health WC |
$14,570.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,285.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,885.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,222.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,113.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,999.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,999.40
|
| Rate for Payer: Multiplan Commercial |
$13,713.60
|
| Rate for Payer: Networks By Design Commercial |
$11,142.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,570.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,285.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,571.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,571.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,571.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,571.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,570.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,570.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14,570.70
|
|
|
HC INTRAVASC LITHO FEM AND POP VASC SAME ARTERY
|
Facility
|
IP
|
$17,142.00
|
|
|
Service Code
|
CPT 37279
|
| Hospital Charge Code |
906811845
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,428.40 |
| Max. Negotiated Rate |
$14,570.70 |
| Rate for Payer: Adventist Health Commercial |
$3,428.40
|
| Rate for Payer: Cash Price |
$7,713.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,999.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,856.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,856.80
|
| Rate for Payer: Galaxy Health WC |
$14,570.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,285.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,885.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,113.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,114.08
|
| Rate for Payer: Multiplan Commercial |
$13,713.60
|
| Rate for Payer: Networks By Design Commercial |
$11,142.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,570.70
|
|
|
HC INTRAVASC LITHO IVT SAME ARTERY
|
Facility
|
OP
|
$11,996.00
|
|
|
Service Code
|
CPT 37262
|
| Hospital Charge Code |
906811828
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,399.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,399.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,196.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,597.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,997.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,697.83
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$5,398.20
|
| Rate for Payer: Cash Price |
$5,398.20
|
| Rate for Payer: Cigna of CA HMO |
$7,677.44
|
| Rate for Payer: Cigna of CA PPO |
$8,877.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,196.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,196.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,196.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,397.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,798.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,798.40
|
| Rate for Payer: Galaxy Health WC |
$10,196.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,197.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,617.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,077.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,879.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,397.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,397.20
|
| Rate for Payer: Multiplan Commercial |
$9,596.80
|
| Rate for Payer: Networks By Design Commercial |
$7,797.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,196.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,197.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,998.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,998.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,998.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,998.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,196.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,196.60
|
| Rate for Payer: Vantage Medical Group Senior |
$10,196.60
|
|
|
HC INTRAVASC LITHO IVT SAME ARTERY
|
Facility
|
IP
|
$11,996.00
|
|
|
Service Code
|
CPT 37262
|
| Hospital Charge Code |
906811828
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,399.20 |
| Max. Negotiated Rate |
$10,196.60 |
| Rate for Payer: Adventist Health Commercial |
$2,399.20
|
| Rate for Payer: Cash Price |
$5,398.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,397.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,798.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,798.40
|
| Rate for Payer: Galaxy Health WC |
$10,196.60
|
| Rate for Payer: Global Benefits Group Commercial |
$7,197.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,617.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,077.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,879.04
|
| Rate for Payer: Multiplan Commercial |
$9,596.80
|
| Rate for Payer: Networks By Design Commercial |
$7,797.40
|
| Rate for Payer: Prime Health Services Commercial |
$10,196.60
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
OP
|
$5,572.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,114.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,114.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,736.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,064.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,179.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,575.55
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,507.40
|
| Rate for Payer: Cash Price |
$2,507.40
|
| Rate for Payer: Cigna of CA HMO |
$3,621.80
|
| Rate for Payer: Cigna of CA PPO |
$4,123.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,736.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,736.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,736.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,900.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,228.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,228.80
|
| Rate for Payer: Galaxy Health WC |
$4,736.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,343.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,538.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,022.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,337.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,900.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,900.40
|
| Rate for Payer: Multiplan Commercial |
$4,457.60
|
| Rate for Payer: Networks By Design Commercial |
$3,621.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,736.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,343.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,343.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,786.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,786.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,786.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,786.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,736.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,736.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,736.20
|
|
|
HC INTRAVSCLR CATH BASED CORO VSS
|
Facility
|
IP
|
$5,572.00
|
|
|
Service Code
|
CPT 0205T
|
| Hospital Charge Code |
906800205
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,114.40 |
| Max. Negotiated Rate |
$4,736.20 |
| Rate for Payer: Adventist Health Commercial |
$1,114.40
|
| Rate for Payer: Cash Price |
$2,507.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,900.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,228.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,228.80
|
| Rate for Payer: Galaxy Health WC |
$4,736.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,343.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,538.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,337.28
|
| Rate for Payer: Multiplan Commercial |
$4,457.60
|
| Rate for Payer: Networks By Design Commercial |
$3,621.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,736.20
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$801.55 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
|
|
HC INTRAVSCLR US EA ADD VESSEL
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
909037253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$518.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cigna of CA HMO |
$603.52
|
| Rate for Payer: Cigna of CA PPO |
$697.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$801.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$801.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$801.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$328.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$371.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$660.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$660.10
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$471.50
|
| 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 |
$801.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$801.55
|
| Rate for Payer: Vantage Medical Group Senior |
$801.55
|
|
|
HC INTRAVSCLR US INIT NONCOR VSSL
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
909037252
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$188.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$518.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$707.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Cigna of CA HMO |
$603.52
|
| Rate for Payer: Cigna of CA PPO |
$697.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$801.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$801.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$801.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$660.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Senior |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,186.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$598.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,472.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$556.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$660.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$660.10
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Networks By Design Commercial |
$612.95
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$471.50
|
| 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 |
$801.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$801.55
|
| Rate for Payer: Vantage Medical Group Senior |
$801.55
|
|
