|
HC LIGATION HEMORRHOID(S)
|
Facility
|
IP
|
$4,963.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$992.60 |
| Max. Negotiated Rate |
$4,218.55 |
| Rate for Payer: Adventist Health Commercial |
$992.60
|
| Rate for Payer: Cash Price |
$2,233.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,985.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,985.20
|
| Rate for Payer: Galaxy Health WC |
$4,218.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,310.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,890.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,072.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.12
|
| Rate for Payer: Multiplan Commercial |
$3,970.40
|
| Rate for Payer: Networks By Design Commercial |
$3,225.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,218.55
|
|
|
HC LIGATION HEMORRHOID(S)
|
Facility
|
OP
|
$2,968.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$129.48 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$593.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cash Price |
$1,335.60
|
| Rate for Payer: Cigna of CA HMO |
$1,899.52
|
| Rate for Payer: Cigna of CA PPO |
$2,196.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$2,522.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,780.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$129.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,979.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$712.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,374.40
|
| Rate for Payer: Networks By Design Commercial |
$1,929.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,522.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,780.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC LIGATION HEMORRHOID(S)
|
Facility
|
IP
|
$4,963.00
|
|
|
Service Code
|
CPT 46221
|
| Hospital Charge Code |
906746221
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$992.60 |
| Max. Negotiated Rate |
$4,218.55 |
| Rate for Payer: Adventist Health Commercial |
$992.60
|
| Rate for Payer: Cash Price |
$2,233.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,985.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,985.20
|
| Rate for Payer: Galaxy Health WC |
$4,218.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,977.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,310.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,890.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,072.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.12
|
| Rate for Payer: Multiplan Commercial |
$3,970.40
|
| Rate for Payer: Networks By Design Commercial |
$3,225.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,218.55
|
|
|
HC LIGATION OF NECK ARTERY
|
Facility
|
IP
|
$4,251.00
|
|
|
Service Code
|
CPT 37615
|
| Hospital Charge Code |
900501435
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$850.20 |
| Max. Negotiated Rate |
$3,613.35 |
| Rate for Payer: Adventist Health Commercial |
$850.20
|
| Rate for Payer: Cash Price |
$1,912.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,700.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,700.40
|
| Rate for Payer: Galaxy Health WC |
$3,613.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,550.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,835.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,619.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,631.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.24
|
| Rate for Payer: Multiplan Commercial |
$3,400.80
|
| Rate for Payer: Networks By Design Commercial |
$2,763.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,613.35
|
|
|
HC LIGATION OF NECK ARTERY
|
Facility
|
OP
|
$4,251.00
|
|
|
Service Code
|
CPT 37615
|
| Hospital Charge Code |
900501435
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$850.20 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$850.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$1,912.95
|
| Rate for Payer: Cash Price |
$1,912.95
|
| Rate for Payer: Cash Price |
$1,912.95
|
| Rate for Payer: Cigna of CA HMO |
$2,720.64
|
| Rate for Payer: Cigna of CA PPO |
$3,145.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$3,613.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,550.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,835.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$3,400.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$2,763.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,613.35
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,550.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,125.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,125.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,125.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,125.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC LIMB MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
901300023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$150.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$234.88
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.90
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
|
HC LIMB MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
901300023
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
|
HC LIMB MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900400008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
|
HC LIMB MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
900400008
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$150.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$234.88
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.90
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
|
HC LIMB MUSCLE TESTING MANUAL OT
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
905104402
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
|
HC LIMB MUSCLE TESTING MANUAL OT
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 95831
|
| Hospital Charge Code |
905104402
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$88.08 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$150.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$201.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$275.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: Cigna of CA HMO |
$234.88
|
| Rate for Payer: Cigna of CA PPO |
$271.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$311.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$311.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$311.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$256.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$256.90
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$220.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$220.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$311.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$311.95
|
| Rate for Payer: Vantage Medical Group Senior |
$311.95
|
|
|
HC LIMITED MOTION ANKLE JOINT EA
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L2200
|
| Hospital Charge Code |
915352200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.45
|
| Rate for Payer: Blue Shield of California Commercial |
$97.42
|
| Rate for Payer: Blue Shield of California EPN |
$64.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC LIMITED MOTION ANKLE JOINT EA
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L2200
|
| Hospital Charge Code |
915352200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC LIMITED MOTION ANKLE JOINT EA
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L2200
|
| Hospital Charge Code |
905352200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC LIMITED MOTION ANKLE JOINT EA
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L2200
|
| Hospital Charge Code |
905352200
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.45
|
| Rate for Payer: Blue Shield of California Commercial |
$97.42
|
| Rate for Payer: Blue Shield of California EPN |
$64.15
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC LIPASE
|
Facility
|
IP
|
$206.40
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900910334
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$175.44 |
| Rate for Payer: Adventist Health Commercial |
$41.28
|
| Rate for Payer: Cash Price |
$92.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.56
|
| Rate for Payer: EPIC Health Plan Senior |
$82.56
|
| Rate for Payer: Galaxy Health WC |
$175.44
|
| Rate for Payer: Global Benefits Group Commercial |
$123.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.54
|
| Rate for Payer: Multiplan Commercial |
$165.12
|
| Rate for Payer: Networks By Design Commercial |
$134.16
|
| Rate for Payer: Prime Health Services Commercial |
$175.44
|
|
|
HC LIPASE
|
Facility
|
OP
|
$70.26
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900910334
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$67.96 |
| Rate for Payer: Adventist Health Commercial |
$14.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.96
|
| Rate for Payer: Blue Shield of California Commercial |
$47.00
|
| Rate for Payer: Blue Shield of California EPN |
$31.05
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cash Price |
$31.62
|
| Rate for Payer: Cigna of CA HMO |
$44.97
|
| Rate for Payer: Cigna of CA PPO |
$51.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$59.72
|
| Rate for Payer: Global Benefits Group Commercial |
$42.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$56.21
|
| Rate for Payer: Networks By Design Commercial |
$45.67
|
| Rate for Payer: Prime Health Services Commercial |
$59.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC LIPASE BODY FLUID
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC LIPASE BODY FLUID
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
900912244
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$67.96 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.96
|
| Rate for Payer: Blue Shield of California Commercial |
$36.13
|
| Rate for Payer: Blue Shield of California EPN |
$23.87
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO |
$34.56
|
| Rate for Payer: Cigna of CA PPO |
$39.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.89
|
| Rate for Payer: Galaxy Health WC |
$45.90
|
| Rate for Payer: Global Benefits Group Commercial |
$32.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.23
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Networks By Design Commercial |
$35.10
|
| Rate for Payer: Prime Health Services Commercial |
$45.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.58
|
| Rate for Payer: United Healthcare All Other HMO |
$5.58
|
| Rate for Payer: United Healthcare HMO Rider |
$5.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.58
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Vantage Medical Group Senior |
$6.89
|
|
|
HC LIPID PANEL MC
|
Facility
|
OP
|
$39.62
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
900912170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$132.26 |
| Rate for Payer: Adventist Health Commercial |
$7.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.26
|
| Rate for Payer: Blue Shield of California Commercial |
$26.51
|
| Rate for Payer: Blue Shield of California EPN |
$17.51
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cash Price |
$17.83
|
| Rate for Payer: Cigna of CA HMO |
$25.36
|
| Rate for Payer: Cigna of CA PPO |
$29.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.08
|
| Rate for Payer: EPIC Health Plan Senior |
$13.39
|
| Rate for Payer: Galaxy Health WC |
$33.68
|
| Rate for Payer: Global Benefits Group Commercial |
$23.77
|
| Rate for Payer: Heritage Provider Network Commercial |
$21.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.94
|
| Rate for Payer: Multiplan Commercial |
$31.70
|
| Rate for Payer: Networks By Design Commercial |
$25.75
|
| Rate for Payer: Prime Health Services Commercial |
$33.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.85
|
| Rate for Payer: United Healthcare All Other HMO |
$10.85
|
| Rate for Payer: United Healthcare HMO Rider |
$10.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.73
|
| Rate for Payer: Vantage Medical Group Senior |
$13.39
|
|
|
HC LIPID PANEL MC
|
Facility
|
IP
|
$44.02
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
900912170
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$37.42 |
| Rate for Payer: Adventist Health Commercial |
$8.80
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.42
|
| Rate for Payer: Global Benefits Group Commercial |
$26.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.56
|
| Rate for Payer: Multiplan Commercial |
$35.22
|
| Rate for Payer: Networks By Design Commercial |
$28.61
|
| Rate for Payer: Prime Health Services Commercial |
$37.42
|
|
|
HC LIQUID COILS
|
Facility
|
IP
|
$1,030.40
|
|
| Hospital Charge Code |
909081813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.08 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$206.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Cigna of CA HMO |
$721.28
|
| Rate for Payer: Cigna of CA PPO |
$721.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.16
|
| Rate for Payer: EPIC Health Plan Senior |
$412.16
|
| Rate for Payer: Galaxy Health WC |
$875.84
|
| Rate for Payer: Global Benefits Group Commercial |
$618.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$687.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$392.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$637.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.30
|
| Rate for Payer: Multiplan Commercial |
$824.32
|
| Rate for Payer: Networks By Design Commercial |
$515.20
|
| Rate for Payer: Prime Health Services Commercial |
$875.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.71
|
| Rate for Payer: United Healthcare All Other HMO |
$376.41
|
| Rate for Payer: United Healthcare HMO Rider |
$368.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.46
|
|
|
HC LIQUID COILS
|
Facility
|
OP
|
$1,030.40
|
|
| Hospital Charge Code |
909081813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$206.08 |
| Max. Negotiated Rate |
$875.84 |
| Rate for Payer: Adventist Health Commercial |
$206.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$875.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$772.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$596.81
|
| Rate for Payer: Blue Shield of California Commercial |
$760.44
|
| Rate for Payer: Blue Shield of California EPN |
$500.77
|
| Rate for Payer: Cash Price |
$463.68
|
| Rate for Payer: Cigna of CA HMO |
$721.28
|
| Rate for Payer: Cigna of CA PPO |
$721.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$875.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$875.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$875.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.16
|
| Rate for Payer: EPIC Health Plan Senior |
$412.16
|
| Rate for Payer: Galaxy Health WC |
$875.84
|
| Rate for Payer: Global Benefits Group Commercial |
$618.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$687.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$392.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$637.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$721.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$721.28
|
| Rate for Payer: Multiplan Commercial |
$824.32
|
| Rate for Payer: Networks By Design Commercial |
$515.20
|
| Rate for Payer: Prime Health Services Commercial |
$875.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$618.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$618.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.71
|
| Rate for Payer: United Healthcare All Other HMO |
$376.41
|
| Rate for Payer: United Healthcare HMO Rider |
$368.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$875.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$875.84
|
| Rate for Payer: Vantage Medical Group Senior |
$875.84
|
|
|
HC LITHIUM
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
900910332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$51.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC LITHIUM
|
Facility
|
OP
|
$71.00
|
|
|
Service Code
|
CPT 80178
|
| Hospital Charge Code |
900910332
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$65.23 |
| Rate for Payer: Adventist Health Commercial |
$14.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.23
|
| Rate for Payer: Blue Shield of California Commercial |
$47.50
|
| Rate for Payer: Blue Shield of California EPN |
$31.38
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cash Price |
$31.95
|
| Rate for Payer: Cigna of CA HMO |
$45.44
|
| Rate for Payer: Cigna of CA PPO |
$52.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Senior |
$6.61
|
| Rate for Payer: Galaxy Health WC |
$60.35
|
| Rate for Payer: Global Benefits Group Commercial |
$42.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$10.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$56.80
|
| Rate for Payer: Networks By Design Commercial |
$46.15
|
| Rate for Payer: Prime Health Services Commercial |
$60.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.36
|
| Rate for Payer: United Healthcare All Other HMO |
$5.36
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.61
|
|
