|
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 |
$478.00 |
| 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: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.50
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| 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 |
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| 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 |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$109.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.50
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$158.12
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$566.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.31
|
| 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 |
$187.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.59
|
| Rate for Payer: Blue Shield of California Commercial |
$340.59
|
| Rate for Payer: Blue Shield of California Commercial |
$516.14
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$566.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$477.31
|
| 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 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 |
$285.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$233.21
|
| Rate for Payer: Blue Shield of California Commercial |
$340.59
|
| Rate for Payer: Blue Shield of California Commercial |
$516.14
|
| 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 |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$566.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$687.65
|
| Rate for Payer: Global Benefits Group Commercial |
$485.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$194.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| 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 |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
OP
|
$8,182.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$66.50 |
| Max. Negotiated Rate |
$6,954.70 |
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Adventist Health Commercial |
$3,354.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,840.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$3,186.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,727.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| 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/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,195.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,963.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| 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: TriValley Medical Group Commercial/Senior |
$4,909.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
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 |
$6,954.70 |
| Rate for Payer: Adventist Health Commercial |
$1,636.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,124.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$3,186.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,336.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,124.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,727.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,504.98
|
| Rate for Payer: EPIC Health Plan Senior |
$2,336.65
|
| 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/Senior |
$3,483.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,124.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,195.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,283.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,963.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,676.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,846.47
|
| 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 |
$2,124.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,186.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,336.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,124.23
|
|
|
HC MASTOTOMY W/EXPLR/DRAIN ABSCES
|
Facility
|
IP
|
$8,182.00
|
|
|
Service Code
|
CPT 19020
|
| Hospital Charge Code |
900501496
|
|
Hospital Revenue Code
|
456
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,727.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,195.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,827.38
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,727.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,195.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,827.38
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$465.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,476.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,371.75
|
| 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 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 |
$1,407.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,178.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,787.92
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,476.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$843.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,371.75
|
| 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 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 |
$2,412.12
|
| Rate for Payer: Blue Shield of California Commercial |
$2,020.39
|
| Rate for Payer: Blue Shield of California Commercial |
$3,064.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,530.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,446.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,351.15
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$797.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,530.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,351.15
|
| 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 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 |
$2,663.32
|
| Rate for Payer: Blue Shield of California Commercial |
$2,230.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,383.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,794.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,597.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,596.00
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$880.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$2,794.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,596.00
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,914.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,086.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,513.65
|
| 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 |
$12,562.92 |
| Rate for Payer: Adventist Health Commercial |
$2,547.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,613.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| 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 |
$11,420.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,375.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,613.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,914.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,562.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8,375.28
|
| 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/Senior |
$12,486.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,613.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,086.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,184.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,593.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,202.61
|
| 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 |
$7,613.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,420.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,375.28
|
| Rate for Payer: Vantage Medical Group Senior |
$7,613.89
|
|
|
HC MEASLES AB
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 86765
|
| Hospital Charge Code |
900913530
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
| Rate for Payer: Vantage Medical Group Senior |
$12.88
|
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.00
|
| Rate for Payer: Blue Shield of California Commercial |
$34.11
|
| Rate for Payer: Blue Shield of California Commercial |
$146.37
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California Commercial |
$96.81
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.25
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: EPIC Health Plan Senior |
$14.17
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.26
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare All Other HMO |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare HMO Rider |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.32
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$147.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$133.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.90
|
| 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
|
|
|
HC MEASLES ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890243
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC MEASLES ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890243
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC MECHANICAL CHEST WALL OSCILL
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
900100003
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$75.80 |
| Max. Negotiated Rate |
$322.15 |
| Rate for Payer: Adventist Health Commercial |
$75.80
|
| Rate for Payer: Cash Price |
$170.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$265.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.60
|
| Rate for Payer: EPIC Health Plan Senior |
$151.60
|
| Rate for Payer: Galaxy Health WC |
$322.15
|
| Rate for Payer: Global Benefits Group Commercial |
$227.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$223.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.96
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: Networks By Design Commercial |
$246.35
|
| Rate for Payer: Prime Health Services Commercial |
$322.15
|
|
