|
HC OPEN TREAT INTERPHALANGEAL DIS
|
Facility
|
IP
|
$13,347.00
|
|
|
Service Code
|
CPT 26785
|
| Hospital Charge Code |
900501654
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,669.40 |
| Max. Negotiated Rate |
$11,344.95 |
| Rate for Payer: Adventist Health Commercial |
$2,669.40
|
| Rate for Payer: Cash Price |
$7,340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,338.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,338.80
|
| Rate for Payer: Galaxy Health WC |
$11,344.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,008.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,902.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,085.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,261.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,203.28
|
| Rate for Payer: Multiplan Commercial |
$10,677.60
|
| Rate for Payer: Networks By Design Commercial |
$8,675.55
|
| Rate for Payer: Prime Health Services Commercial |
$11,344.95
|
|
|
HC OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
OP
|
$7,491.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$229.90 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| 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 |
$8,922.00
|
| Rate for Payer: Cash Price |
$4,120.05
|
| Rate for Payer: Cash Price |
$4,120.05
|
| Rate for Payer: Cash Price |
$4,120.05
|
| Rate for Payer: Cigna of CA HMO |
$4,794.24
|
| Rate for Payer: Cigna of CA PPO |
$5,543.34
|
| 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 |
$6,367.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,494.60
|
| 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 |
$4,996.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,516.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,797.84
|
| 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 |
$5,992.80
|
| Rate for Payer: Multiplan WC |
$11,976.10
|
| Rate for Payer: Networks By Design Commercial |
$4,869.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,367.35
|
| Rate for Payer: Prime Health Services WC |
$11,853.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,494.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,745.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,745.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,745.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,745.50
|
| 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 OPEN TREAT MANDIBULAR FX W/INT
|
Facility
|
IP
|
$7,491.00
|
|
|
Service Code
|
CPT 21462
|
| Hospital Charge Code |
900501697
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,498.20 |
| Max. Negotiated Rate |
$6,367.35 |
| Rate for Payer: Adventist Health Commercial |
$1,498.20
|
| Rate for Payer: Cash Price |
$4,120.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,996.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,996.40
|
| Rate for Payer: Galaxy Health WC |
$6,367.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,494.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,996.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,854.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,636.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,797.84
|
| Rate for Payer: Multiplan Commercial |
$5,992.80
|
| Rate for Payer: Networks By Design Commercial |
$4,869.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,367.35
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
IP
|
$8,507.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,701.40 |
| Max. Negotiated Rate |
$7,230.95 |
| Rate for Payer: Adventist Health Commercial |
$1,701.40
|
| Rate for Payer: Cash Price |
$4,678.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,402.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,402.80
|
| Rate for Payer: Galaxy Health WC |
$7,230.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,104.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,241.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,265.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,041.68
|
| Rate for Payer: Multiplan Commercial |
$6,805.60
|
| Rate for Payer: Networks By Design Commercial |
$5,529.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,230.95
|
|
|
HC OPEN TREAT METACARPAL FX SNGL
|
Facility
|
OP
|
$8,507.00
|
|
|
Service Code
|
CPT 26615
|
| Hospital Charge Code |
900501555
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$112.48 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,701.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$4,678.85
|
| Rate for Payer: Cash Price |
$4,678.85
|
| Rate for Payer: Cash Price |
$4,678.85
|
| Rate for Payer: Cigna of CA HMO |
$5,444.48
|
| Rate for Payer: Cigna of CA PPO |
$6,295.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$7,230.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,104.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,041.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$6,805.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,529.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,230.95
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,104.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,253.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,253.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,253.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,253.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
IP
|
$14,930.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,986.00 |
| Max. Negotiated Rate |
$12,690.50 |
| Rate for Payer: Adventist Health Commercial |
$2,986.00
|
| Rate for Payer: Cash Price |
$8,211.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,972.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,972.00
|
| Rate for Payer: Galaxy Health WC |
$12,690.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,958.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,958.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,688.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,241.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,583.20
|
| Rate for Payer: Multiplan Commercial |
$11,944.00
|
| Rate for Payer: Networks By Design Commercial |
$9,704.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,690.50
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
OP
|
$14,930.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$891.99 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$2,986.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$8,211.50
|
| Rate for Payer: Cash Price |
$8,211.50
|
| Rate for Payer: Cash Price |
$8,211.50
|
| Rate for Payer: Cigna of CA HMO |
$9,555.20
|
| Rate for Payer: Cigna of CA PPO |
$11,048.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$12,690.50
|
| Rate for Payer: Global Benefits Group Commercial |
$8,958.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,958.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,583.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$11,944.00
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$9,704.50
|
| Rate for Payer: Prime Health Services Commercial |
$12,690.50
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,958.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,465.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,465.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,465.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,465.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
OP
|
$6,803.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.46 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$1,360.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,741.65
|
| Rate for Payer: Cash Price |
$3,741.65
|
| Rate for Payer: Cash Price |
$3,741.65
|
| Rate for Payer: Cigna of CA HMO |
$4,353.92
|
| Rate for Payer: Cigna of CA PPO |
$5,034.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$5,782.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,081.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,632.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$5,442.40
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$4,421.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,782.55
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,081.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,401.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,401.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,401.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,401.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
IP
|
$6,803.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,360.60 |
| Max. Negotiated Rate |
$5,782.55 |
| Rate for Payer: Adventist Health Commercial |
$1,360.60
|
| Rate for Payer: Cash Price |
$3,741.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,721.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,721.20
|
| Rate for Payer: Galaxy Health WC |
$5,782.55
|
| Rate for Payer: Global Benefits Group Commercial |
$4,081.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,537.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,591.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,211.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,632.72
|
| Rate for Payer: Multiplan Commercial |
$5,442.40
|
| Rate for Payer: Networks By Design Commercial |
$4,421.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,782.55
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
IP
|
$1,186.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$237.20 |
| Max. Negotiated Rate |
$1,008.10 |
| Rate for Payer: Adventist Health Commercial |
$237.20
|
| Rate for Payer: Cash Price |
$652.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.40
|
| Rate for Payer: EPIC Health Plan Senior |
$474.40
|
| Rate for Payer: Galaxy Health WC |
$1,008.10
|
| Rate for Payer: Global Benefits Group Commercial |
$711.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$451.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.64
|
| Rate for Payer: Multiplan Commercial |
$948.80
|
| Rate for Payer: Networks By Design Commercial |
$770.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.10
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
OP
|
$1,186.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$70.03 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$237.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,008.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$652.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$652.30
|
| Rate for Payer: Cash Price |
$652.30
|
| Rate for Payer: Cash Price |
$652.30
|
| Rate for Payer: Cigna of CA HMO |
$759.04
|
| Rate for Payer: Cigna of CA PPO |
$877.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,008.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,008.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,008.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.40
|
| Rate for Payer: EPIC Health Plan Senior |
$474.40
|
| Rate for Payer: Galaxy Health WC |
$1,008.10
|
| Rate for Payer: Global Benefits Group Commercial |
$711.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$830.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$830.20
|
| Rate for Payer: Multiplan Commercial |
$948.80
|
| Rate for Payer: Networks By Design Commercial |
$770.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$711.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$593.00
|
| Rate for Payer: United Healthcare All Other HMO |
$593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$593.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,008.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,008.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,008.10
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
IP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.40 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Cash Price |
$652.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.80
|
| Rate for Payer: EPIC Health Plan Senior |
$474.80
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$734.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
OP
|
$1,187.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.88 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$728.94
|
| Rate for Payer: Blue Shield of California Commercial |
$726.44
|
| Rate for Payer: Blue Shield of California EPN |
$479.55
|
| Rate for Payer: Cash Price |
$652.85
|
| Rate for Payer: Cash Price |
$652.85
|
| Rate for Payer: Cigna of CA HMO |
$759.68
|
| Rate for Payer: Cigna of CA PPO |
$878.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,008.95
|
| Rate for Payer: Global Benefits Group Commercial |
$712.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$791.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$949.60
|
| Rate for Payer: Networks By Design Commercial |
$771.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,008.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$712.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$712.20
|
| 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 |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.32 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$332.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$278.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$380.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.37
|
| Rate for Payer: Blue Shield of California Commercial |
$310.28
|
| Rate for Payer: Blue Shield of California EPN |
$204.83
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: Cigna of CA HMO |
$324.48
|
| Rate for Payer: Cigna of CA PPO |
$375.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$430.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$430.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$430.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$354.90
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$304.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$304.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$253.50
|
| Rate for Payer: United Healthcare All Other HMO |
$253.50
|
| Rate for Payer: United Healthcare HMO Rider |
$253.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$253.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$430.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$430.95
|
| Rate for Payer: Vantage Medical Group Senior |
$430.95
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
IP
|
$964.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.80 |
| Max. Negotiated Rate |
$819.40 |
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Cash Price |
$530.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
OP
|
$964.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.71 |
| Max. Negotiated Rate |
$819.40 |
| Rate for Payer: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$632.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$819.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$530.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$723.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$591.99
|
| Rate for Payer: Blue Shield of California Commercial |
$589.97
|
| Rate for Payer: Blue Shield of California EPN |
$389.46
|
| Rate for Payer: Cash Price |
$530.20
|
| Rate for Payer: Cash Price |
$530.20
|
| Rate for Payer: Cigna of CA HMO |
$616.96
|
| Rate for Payer: Cigna of CA PPO |
$713.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$819.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$819.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$819.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Senior |
$385.60
|
| Rate for Payer: Galaxy Health WC |
$819.40
|
| Rate for Payer: Global Benefits Group Commercial |
$578.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$674.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$674.80
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: Networks By Design Commercial |
$626.60
|
| Rate for Payer: Prime Health Services Commercial |
$819.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$578.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$578.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$482.00
|
| Rate for Payer: United Healthcare All Other HMO |
$482.00
|
| Rate for Payer: United Healthcare HMO Rider |
$482.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$482.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$819.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$819.40
|
| Rate for Payer: Vantage Medical Group Senior |
$819.40
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
IP
|
$9,032.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,806.40 |
| Max. Negotiated Rate |
$7,677.20 |
| Rate for Payer: Adventist Health Commercial |
$1,806.40
|
| Rate for Payer: Cash Price |
$4,967.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,612.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,612.80
|
| Rate for Payer: Galaxy Health WC |
$7,677.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,419.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,024.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,441.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,590.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,167.68
|
| Rate for Payer: Multiplan Commercial |
$7,225.60
|
| Rate for Payer: Networks By Design Commercial |
$5,870.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,677.20
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
OP
|
$9,032.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$424.42 |
| Max. Negotiated Rate |
$7,677.20 |
| Rate for Payer: Adventist Health Commercial |
$1,806.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,191.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$4,967.60
|
| Rate for Payer: Cash Price |
$4,967.60
|
| Rate for Payer: Cash Price |
$4,967.60
|
| Rate for Payer: Cigna of CA HMO |
$5,780.48
|
| Rate for Payer: Cigna of CA PPO |
$6,683.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,410.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,191.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,958.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.11
|
| Rate for Payer: Galaxy Health WC |
$7,677.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,419.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,593.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,191.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,024.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,191.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,167.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,936.09
|
| Rate for Payer: Multiplan Commercial |
$7,225.60
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$5,870.80
|
| Rate for Payer: Prime Health Services Commercial |
$7,677.20
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,419.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,516.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,516.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,516.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,516.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,191.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,286.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,410.22
|
| Rate for Payer: Vantage Medical Group Senior |
$2,191.11
|
|
|
HC OP EXTEND RECOVERY ADDL 30 MIN
|
Facility
|
IP
|
$142.00
|
|
| Hospital Charge Code |
988100100
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC OP EXTEND RECOVERY ADDL 30 MIN
|
Facility
|
OP
|
$142.00
|
|
| Hospital Charge Code |
988100100
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$106.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.20
|
| Rate for Payer: Cash Price |
$78.10
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$99.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$99.40
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71.00
|
| Rate for Payer: United Healthcare HMO Rider |
$71.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$91.20 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.40
|
| Rate for Payer: EPIC Health Plan Senior |
$182.40
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$173.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$72.39 |
| Max. Negotiated Rate |
$387.60 |
| Rate for Payer: Adventist Health Commercial |
$91.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.09
|
| 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 |
$280.03
|
| Rate for Payer: Blue Shield of California Commercial |
$279.07
|
| Rate for Payer: Blue Shield of California EPN |
$184.22
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna of CA HMO |
$291.84
|
| Rate for Payer: Cigna of CA PPO |
$337.44
|
| 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 |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| 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 |
$364.80
|
| Rate for Payer: Networks By Design Commercial |
$296.40
|
| Rate for Payer: Prime Health Services Commercial |
$387.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| 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 OPIATES CONF & ID
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.16
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
|
|
HC OPIATES CONF & ID
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.33
|
| Rate for Payer: Blue Shield of California Commercial |
$240.17
|
| Rate for Payer: Blue Shield of California EPN |
$158.68
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: Cash Price |
$197.45
|
| Rate for Payer: Cigna of CA HMO |
$229.76
|
| Rate for Payer: Cigna of CA PPO |
$265.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$305.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$239.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$136.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$222.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$251.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$251.30
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$215.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$215.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.50
|
| Rate for Payer: United Healthcare All Other HMO |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$179.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.15
|
| Rate for Payer: Vantage Medical Group Senior |
$305.15
|
|
