|
HC MARCH BAR, SHOE ADD
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
905353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
915353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
915353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.49
|
| Rate for Payer: Blue Shield of California Commercial |
$60.52
|
| Rate for Payer: Blue Shield of California EPN |
$39.85
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC MARCH BAR, SHOE ADD
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT L3595
|
| Hospital Charge Code |
905353595
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.13 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.49
|
| Rate for Payer: Blue Shield of California Commercial |
$60.52
|
| Rate for Payer: Blue Shield of California EPN |
$39.85
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna of CA HMO |
$57.40
|
| Rate for Payer: Cigna of CA PPO |
$57.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$41.00
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.77
|
| Rate for Payer: United Healthcare All Other HMO |
$29.95
|
| Rate for Payer: United Healthcare HMO Rider |
$29.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC MARSUPIALIZATION OF BARTHOLINS GLAND CYST
|
Facility
|
OP
|
$6,159.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
900556440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$385.09 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,231.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: Cigna of CA HMO |
$3,941.76
|
| Rate for Payer: Cigna of CA PPO |
$4,557.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$5,235.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,695.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,478.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$4,927.20
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,003.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,235.15
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,695.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,079.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,079.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,079.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,079.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC MARSUPIALIZATION OF BARTHOLINS GLAND CYST
|
Facility
|
IP
|
$6,159.00
|
|
|
Service Code
|
CPT 56440
|
| Hospital Charge Code |
900556440
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,231.80 |
| Max. Negotiated Rate |
$5,235.15 |
| Rate for Payer: Adventist Health Commercial |
$1,231.80
|
| Rate for Payer: Cash Price |
$2,771.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,463.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,463.60
|
| Rate for Payer: Galaxy Health WC |
$5,235.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,695.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,346.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,812.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,478.16
|
| Rate for Payer: Multiplan Commercial |
$4,927.20
|
| Rate for Payer: Networks By Design Commercial |
$4,003.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,235.15
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
901300056
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| 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 |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
901300056
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$227.80 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC MASSAGE 15 MIN MCAL
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 97124
|
| Hospital Charge Code |
900400048
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$17.29 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.00
|
| 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 |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Senior |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$165.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.60
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.80
|
| 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 |
$227.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC MASTOID CHILD
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC MASTOID CHILD
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
909001132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$530.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.69
|
| Rate for Payer: Blue Shield of California Commercial |
$495.11
|
| Rate for Payer: Blue Shield of California EPN |
$326.84
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$485.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC MASTOID COMPLETE
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.01 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$530.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.16
|
| Rate for Payer: Blue Shield of California Commercial |
$495.11
|
| Rate for Payer: Blue Shield of California EPN |
$326.84
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: Cigna of CA HMO |
$517.76
|
| Rate for Payer: Cigna of CA PPO |
$598.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$485.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$485.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC MASTOID COMPLETE
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
909001131
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.80 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Adventist Health Commercial |
$161.80
|
| Rate for Payer: Cash Price |
$364.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.60
|
| Rate for Payer: EPIC Health Plan Senior |
$323.60
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$539.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$500.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: Networks By Design Commercial |
$525.85
|
| Rate for Payer: Prime Health Services Commercial |
$687.65
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
IP
|
$8,182.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,636.40 |
| Max. Negotiated Rate |
$6,954.70 |
| Rate for Payer: Adventist Health Commercial |
$1,636.40
|
| Rate for Payer: Cash Price |
$3,681.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,272.80
|
| Rate for Payer: Galaxy Health WC |
$6,954.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,909.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,457.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,117.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,064.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,963.68
|
| Rate for Payer: Multiplan Commercial |
$6,545.60
|
| Rate for Payer: Networks By Design Commercial |
$5,318.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,954.70
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
OP
|
$8,182.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,636.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,681.90
|
| Rate for Payer: Cash Price |
$3,681.90
|
| Rate for Payer: Cash Price |
$3,681.90
|
| Rate for Payer: Cigna of CA HMO |
$5,236.48
|
| Rate for Payer: Cigna of CA PPO |
$6,054.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$6,954.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,909.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,457.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,963.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$6,545.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$5,318.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,954.70
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,909.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,091.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,091.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,091.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
OP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$1,976.25 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,278.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,743.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,346.64
|
| Rate for Payer: Blue Shield of California Commercial |
$1,715.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,129.95
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cigna of CA HMO |
$1,627.50
|
| Rate for Payer: Cigna of CA PPO |
$1,627.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,976.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,976.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,550.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,439.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,627.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,627.50
|
| Rate for Payer: Multiplan Commercial |
$1,860.00
|
| Rate for Payer: Networks By Design Commercial |
$1,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,395.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,395.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$872.57
|
| Rate for Payer: United Healthcare All Other HMO |
$849.32
|
| Rate for Payer: United Healthcare HMO Rider |
$830.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,976.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,976.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,976.25
|
|
|
HC MATRIX 3D FIRM/STD 10 COIL
|
Facility
|
IP
|
$2,325.00
|
|
| Hospital Charge Code |
909081831
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$465.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cash Price |
$1,046.25
|
| Rate for Payer: Cigna of CA HMO |
$1,627.50
|
| Rate for Payer: Cigna of CA PPO |
$1,627.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.00
|
| Rate for Payer: EPIC Health Plan Senior |
$930.00
|
| Rate for Payer: Galaxy Health WC |
$1,976.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,395.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,550.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,439.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.00
|
| Rate for Payer: Multiplan Commercial |
$1,860.00
|
| Rate for Payer: Networks By Design Commercial |
$1,162.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,976.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$872.57
|
| Rate for Payer: United Healthcare All Other HMO |
$849.32
|
| Rate for Payer: United Healthcare HMO Rider |
$830.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.44
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
IP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Cigna of CA HMO |
$2,789.50
|
| Rate for Payer: Cigna of CA PPO |
$2,789.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,594.00
|
| Rate for Payer: Galaxy Health WC |
$3,387.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,391.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,657.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,466.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$956.40
|
| Rate for Payer: Multiplan Commercial |
$3,188.00
|
| Rate for Payer: Networks By Design Commercial |
$1,992.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,387.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,495.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,455.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,424.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.09
|
|
|
HC MATRIX 3D STANDARD 3-8 COIL
|
Facility
|
OP
|
$3,985.00
|
|
| Hospital Charge Code |
909081832
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$797.00 |
| Max. Negotiated Rate |
$3,387.25 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,191.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,988.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,308.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,940.93
|
| Rate for Payer: Blue Shield of California EPN |
$1,936.71
|
| Rate for Payer: Cash Price |
$1,793.25
|
| Rate for Payer: Cigna of CA HMO |
$2,789.50
|
| Rate for Payer: Cigna of CA PPO |
$2,789.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,387.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,387.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,594.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,594.00
|
| Rate for Payer: Galaxy Health WC |
$3,387.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,391.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,657.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,518.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,466.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$956.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,789.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,789.50
|
| Rate for Payer: Multiplan Commercial |
$3,188.00
|
| Rate for Payer: Networks By Design Commercial |
$1,992.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,387.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,391.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,391.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,495.57
|
| Rate for Payer: United Healthcare All Other HMO |
$1,455.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1,424.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,305.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,387.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,387.25
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
IP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cigna of CA HMO |
$3,080.00
|
| Rate for Payer: Cigna of CA PPO |
$3,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,760.00
|
| Rate for Payer: Galaxy Health WC |
$3,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,640.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,934.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,676.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,723.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.00
|
| Rate for Payer: Multiplan Commercial |
$3,520.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,740.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,651.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,607.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,572.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,441.00
|
|
|
HC MATRIX 3D X-FIRM COIL
|
Facility
|
OP
|
$4,400.00
|
|
| Hospital Charge Code |
909081830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$880.00 |
| Max. Negotiated Rate |
$3,740.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,420.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,548.48
|
| Rate for Payer: Blue Shield of California Commercial |
$3,247.20
|
| Rate for Payer: Blue Shield of California EPN |
$2,138.40
|
| Rate for Payer: Cash Price |
$1,980.00
|
| Rate for Payer: Cigna of CA HMO |
$3,080.00
|
| Rate for Payer: Cigna of CA PPO |
$3,080.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,740.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,740.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,760.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,760.00
|
| Rate for Payer: Galaxy Health WC |
$3,740.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,640.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,934.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,676.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,723.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,080.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,080.00
|
| Rate for Payer: Multiplan Commercial |
$3,520.00
|
| Rate for Payer: Networks By Design Commercial |
$2,200.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,740.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,640.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,640.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,651.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,607.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,572.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,740.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,740.00
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
IP
|
$12,735.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,547.00 |
| Max. Negotiated Rate |
$10,824.75 |
| Rate for Payer: Adventist Health Commercial |
$2,547.00
|
| Rate for Payer: Cash Price |
$5,730.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,094.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,094.00
|
| Rate for Payer: Galaxy Health WC |
$10,824.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,641.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,852.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,882.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.40
|
| Rate for Payer: Multiplan Commercial |
$10,188.00
|
| Rate for Payer: Networks By Design Commercial |
$8,277.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,824.75
|
|
|
HC MAXILLOFACIAL FIXATION
|
Facility
|
OP
|
$12,735.00
|
|
|
Service Code
|
CPT 21100
|
| Hospital Charge Code |
900501456
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$290.74 |
| Max. Negotiated Rate |
$12,326.96 |
| Rate for Payer: Adventist Health Commercial |
$2,547.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,516.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,730.75
|
| Rate for Payer: Cash Price |
$5,730.75
|
| Rate for Payer: Cash Price |
$5,730.75
|
| Rate for Payer: Cigna of CA HMO |
$8,150.40
|
| Rate for Payer: Cigna of CA PPO |
$9,423.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,268.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,516.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,147.19
|
| Rate for Payer: EPIC Health Plan Senior |
$7,516.44
|
| Rate for Payer: Galaxy Health WC |
$10,824.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,641.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,326.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,516.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,470.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,072.03
|
| Rate for Payer: Multiplan Commercial |
$10,188.00
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$8,277.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,824.75
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,641.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,367.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,367.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,367.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,367.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,516.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,274.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,268.08
|
| Rate for Payer: Vantage Medical Group Senior |
$7,516.44
|
|
|
HC MEASLES AB
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
