|
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 |
$3,828.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,954.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,401.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,019.13
|
| 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 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 |
$6,718.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,451.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9,480.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,808.70
|
| 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 |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$2,986.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$6,718.50
|
| Rate for Payer: Cash Price |
$6,718.50
|
| Rate for Payer: Cash Price |
$6,718.50
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,451.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| 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/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,480.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,583.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,759.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,505.82
|
| 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 |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
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 |
$3,061.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,762.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,319.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,013.77
|
| 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 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 |
$15,398.95 |
| Rate for Payer: Adventist Health Commercial |
$1,360.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$3,061.35
|
| Rate for Payer: Cash Price |
$3,061.35
|
| Rate for Payer: Cash Price |
$3,061.35
|
| 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 |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,762.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| 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/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,319.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,632.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,759.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,505.82
|
| 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 |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$237.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$533.70
|
| Rate for Payer: Cash Price |
$533.70
|
| Rate for Payer: Cash Price |
$533.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$753.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$699.74
|
| 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 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 |
$533.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$753.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$699.74
|
| 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 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 |
$534.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$700.33
|
| 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 |
$111.93 |
| Max. Negotiated Rate |
$1,008.95 |
| Rate for Payer: Adventist Health Commercial |
$237.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$761.70
|
| Rate for Payer: Blue Shield of California Commercial |
$757.31
|
| Rate for Payer: Blue Shield of California Commercial |
$499.73
|
| Rate for Payer: Cash Price |
$534.15
|
| Rate for Payer: Cash Price |
$534.15
|
| 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 |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$830.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| 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/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$753.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
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 |
$228.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$321.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.13
|
| 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 |
$146.41
|
| 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 |
$202.07
|
| Rate for Payer: Blue Shield of California Commercial |
$323.47
|
| Rate for Payer: Blue Shield of California Commercial |
$213.45
|
| Rate for Payer: Cash Price |
$228.15
|
| Rate for Payer: Cash Price |
$228.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$354.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$321.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$299.13
|
| 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: Adventist Health Commercial |
$192.80
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$612.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$568.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.36
|
| 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
|
|
|
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 |
$239.92
|
| 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: Blue Shield of California Commercial |
$615.03
|
| Rate for Payer: Blue Shield of California Commercial |
$405.84
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cash Price |
$433.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$674.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$612.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$568.76
|
| 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 |
$4,064.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,322.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$5,735.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,328.88
|
| 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 |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$4,064.40
|
| Rate for Payer: Cash Price |
$4,064.40
|
| Rate for Payer: Cash Price |
$4,064.40
|
| 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 |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,322.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| 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/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,735.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,460.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,167.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,884.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,067.59
|
| 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 |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
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 |
$63.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| 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 |
$91.12
|
| Rate for Payer: Cash Price |
$63.90
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$51.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| 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
|
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 |
$290.46
|
| 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 |
$292.62
|
| Rate for Payer: Blue Shield of California Commercial |
$290.93
|
| Rate for Payer: Blue Shield of California Commercial |
$191.98
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| 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 |
$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 |
$319.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$387.60
|
| Rate for Payer: Global Benefits Group Commercial |
$273.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$72.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$289.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$109.44
|
| 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 |
$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 |
$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 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 |
$205.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$319.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$289.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$269.04
|
| 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 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 |
$161.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$227.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.81
|
| 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 |
$0.07 |
| Max. Negotiated Rate |
$305.15 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| 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 Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$192.62
|
| Rate for Payer: Blue Shield of California Commercial |
$250.22
|
| Rate for Payer: Blue Shield of California Commercial |
$137.38
|
| Rate for Payer: Blue Shield of California Commercial |
$207.71
|
| Rate for Payer: Blue Shield of California Commercial |
$165.50
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA HMO |
$229.76
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Cigna of CA PPO |
$265.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$305.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$251.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$251.30
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$215.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$215.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.15
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$305.15
|
|
|
HC OPN FEM ART DELV END PRO, UNI
|
Facility
|
IP
|
$6,408.00
|
|
|
Service Code
|
CPT 34812
|
| Hospital Charge Code |
900034812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,281.60 |
| Max. Negotiated Rate |
$5,446.80 |
| Rate for Payer: Adventist Health Commercial |
$1,281.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,485.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,563.20
|
| Rate for Payer: Galaxy Health WC |
$5,446.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,844.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,069.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,780.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,537.92
|
| Rate for Payer: Multiplan Commercial |
$5,126.40
|
| Rate for Payer: Networks By Design Commercial |
$4,165.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,446.80
|
|
|
HC OPN FEM ART DELV END PRO, UNI
|
Facility
|
OP
|
$6,408.00
|
|
|
Service Code
|
CPT 34812
|
| Hospital Charge Code |
900034812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$106.95 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,281.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,446.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,524.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cash Price |
$2,883.60
|
| Rate for Payer: Cigna of CA HMO |
$4,101.12
|
| Rate for Payer: Cigna of CA PPO |
$4,741.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,446.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,446.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,446.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,485.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,563.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,563.20
|
| Rate for Payer: Galaxy Health WC |
$5,446.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,844.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,069.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,780.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,537.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,485.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,485.60
|
| Rate for Payer: Multiplan Commercial |
$5,126.40
|
| Rate for Payer: Networks By Design Commercial |
$4,165.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,446.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,844.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,446.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,446.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,446.80
|
|
|
HC OPTIC FORAMINA
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$411.40 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.60
|
| Rate for Payer: EPIC Health Plan Senior |
$193.60
|
| Rate for Payer: Galaxy Health WC |
$411.40
|
| Rate for Payer: Global Benefits Group Commercial |
$290.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$307.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$285.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.16
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Networks By Design Commercial |
$314.60
|
| Rate for Payer: Prime Health Services Commercial |
$411.40
|
|
|
HC OPTIC FORAMINA
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.65 |
| Max. Negotiated Rate |
$411.40 |
| Rate for Payer: Adventist Health Commercial |
$96.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$183.59
|
| Rate for Payer: Blue Shield of California Commercial |
$203.76
|
| Rate for Payer: Blue Shield of California Commercial |
$308.79
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cash Price |
$217.80
|
| Rate for Payer: Cigna of CA HMO |
$309.76
|
| Rate for Payer: Cigna of CA PPO |
$358.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$411.40
|
| Rate for Payer: Global Benefits Group Commercial |
$290.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$43.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$307.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Networks By Design Commercial |
$314.60
|
| Rate for Payer: Prime Health Services Commercial |
$411.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$290.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$290.40
|
| 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 |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
