|
HC PAIN MANAGEMENT SERVICES
|
Facility
|
IP
|
$12,171.00
|
|
| Hospital Charge Code |
900700075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,434.20 |
| Max. Negotiated Rate |
$10,345.35 |
| Rate for Payer: Adventist Health Commercial |
$2,434.20
|
| Rate for Payer: Cash Price |
$5,476.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,868.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,868.40
|
| Rate for Payer: Galaxy Health WC |
$10,345.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,302.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,637.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,533.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,921.04
|
| Rate for Payer: Multiplan Commercial |
$9,736.80
|
| Rate for Payer: Networks By Design Commercial |
$7,911.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,345.35
|
|
|
HC PAIN MANAGEMENT SERVICES
|
Facility
|
OP
|
$12,171.00
|
|
| Hospital Charge Code |
900700075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,434.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,434.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,345.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,694.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,474.21
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,476.95
|
| Rate for Payer: Cash Price |
$5,476.95
|
| Rate for Payer: Cigna of CA HMO |
$7,789.44
|
| Rate for Payer: Cigna of CA PPO |
$9,006.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,345.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,345.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,345.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,868.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,868.40
|
| Rate for Payer: Galaxy Health WC |
$10,345.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,302.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,637.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,533.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,921.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,519.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,519.70
|
| Rate for Payer: Multiplan Commercial |
$9,736.80
|
| Rate for Payer: Networks By Design Commercial |
$7,911.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,345.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,302.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,085.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,085.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,085.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,085.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,345.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,345.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10,345.35
|
|
|
HC PALINDROME DIALYS 19CM
|
Facility
|
OP
|
$1,904.40
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901698140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.88 |
| Max. Negotiated Rate |
$1,618.74 |
| Rate for Payer: Adventist Health Commercial |
$380.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,249.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,618.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,047.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,428.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,169.49
|
| Rate for Payer: Cash Price |
$856.98
|
| Rate for Payer: Cigna of CA HMO |
$1,218.82
|
| Rate for Payer: Cigna of CA PPO |
$1,409.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,618.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,618.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,618.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.76
|
| Rate for Payer: EPIC Health Plan Senior |
$761.76
|
| Rate for Payer: Galaxy Health WC |
$1,618.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,270.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,178.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,333.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,333.08
|
| Rate for Payer: Multiplan Commercial |
$1,523.52
|
| Rate for Payer: Networks By Design Commercial |
$1,237.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.20
|
| Rate for Payer: United Healthcare All Other HMO |
$952.20
|
| Rate for Payer: United Healthcare HMO Rider |
$952.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,618.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,618.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,618.74
|
|
|
HC PALINDROME DIALYS 19CM
|
Facility
|
IP
|
$1,904.40
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901698140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.88 |
| Max. Negotiated Rate |
$1,618.74 |
| Rate for Payer: Adventist Health Commercial |
$380.88
|
| Rate for Payer: Cash Price |
$856.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.76
|
| Rate for Payer: EPIC Health Plan Senior |
$761.76
|
| Rate for Payer: Galaxy Health WC |
$1,618.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,270.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,178.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.06
|
| Rate for Payer: Multiplan Commercial |
$1,523.52
|
| Rate for Payer: Networks By Design Commercial |
$1,237.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.74
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$1,997.50 |
| Rate for Payer: Adventist Health Commercial |
$470.00
|
| Rate for Payer: Cash Price |
$1,057.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.00
|
| Rate for Payer: EPIC Health Plan Senior |
$940.00
|
| Rate for Payer: Galaxy Health WC |
$1,997.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,410.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,567.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$895.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,454.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,880.00
|
| Rate for Payer: Networks By Design Commercial |
$1,527.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,997.50
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$470.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,057.50
|
| Rate for Payer: Cash Price |
$1,057.50
|
| Rate for Payer: Cash Price |
$1,057.50
|
| Rate for Payer: Cigna of CA HMO |
$1,504.00
|
| Rate for Payer: Cigna of CA PPO |
$1,739.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$1,997.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,410.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$636.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,567.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$719.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$1,880.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,527.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,997.50
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,410.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$237.80 |
| Max. Negotiated Rate |
$1,010.65 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Cash Price |
$535.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$772.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
OP
|
$1,250.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$250.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$767.62
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cash Price |
$562.50
|
| Rate for Payer: Cigna of CA HMO |
$800.00
|
| Rate for Payer: Cigna of CA PPO |
$925.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,062.50
|
| Rate for Payer: Global Benefits Group Commercial |
$750.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$833.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: Networks By Design Commercial |
$812.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,062.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$750.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,072.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC PANCREATIC PSDOCYST EXT DRN
|
Facility
|
OP
|
$507.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
909000155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$228.15
|
| 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: 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 |
$213.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.93
|
| 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: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: 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 PANCREATIC PSDOCYST EXT DRN
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
909000155
|
|
Hospital Revenue Code
|
361
|
| 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: 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 PANTIES
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.69
|
| Rate for Payer: Blue Shield of California Commercial |
$25.09
|
| Rate for Payer: Blue Shield of California EPN |
$16.52
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$23.80
|
| Rate for Payer: Cigna of CA PPO |
$23.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC PANTIES
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
905380015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$23.80
|
| Rate for Payer: Cigna of CA PPO |
$23.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
|
|
HC PANTIES
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$23.80
|
| Rate for Payer: Cigna of CA PPO |
$23.80
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
|
|
HC PANTIES
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT L8499
|
| Hospital Charge Code |
915380015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$28.90 |
| Rate for Payer: Adventist Health Commercial |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.69
|
| Rate for Payer: Blue Shield of California Commercial |
$25.09
|
| Rate for Payer: Blue Shield of California EPN |
$16.52
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$23.80
|
| Rate for Payer: Cigna of CA PPO |
$23.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.80
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.76
|
| Rate for Payer: United Healthcare All Other HMO |
$12.42
|
| Rate for Payer: United Healthcare HMO Rider |
$12.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.90
|
| Rate for Payer: Vantage Medical Group Senior |
$28.90
|
|
|
HC PAPOOSE INFANT SPINAL IMOBLIZR
|
Facility
|
OP
|
$1,038.86
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901606308
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.33 |
| Max. Negotiated Rate |
$883.03 |
| Rate for Payer: Adventist Health Commercial |
$425.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$883.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$571.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$601.71
|
| Rate for Payer: Blue Shield of California Commercial |
$766.68
|
| Rate for Payer: Blue Shield of California EPN |
$504.89
|
| Rate for Payer: Cash Price |
$467.49
|
| Rate for Payer: Cash Price |
$467.49
|
| Rate for Payer: Cigna of CA HMO |
$727.20
|
| Rate for Payer: Cigna of CA PPO |
$727.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$883.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$883.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$883.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$415.54
|
| Rate for Payer: EPIC Health Plan Senior |
$415.54
|
| Rate for Payer: Galaxy Health WC |
$883.03
|
| Rate for Payer: Global Benefits Group Commercial |
$623.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$307.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$692.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$727.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$727.20
|
| Rate for Payer: Multiplan Commercial |
$831.09
|
| Rate for Payer: Networks By Design Commercial |
$519.43
|
| Rate for Payer: Prime Health Services Commercial |
$883.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$623.32
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$623.32
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.88
|
| Rate for Payer: United Healthcare All Other HMO |
$379.50
|
| Rate for Payer: United Healthcare HMO Rider |
$371.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$883.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$883.03
|
| Rate for Payer: Vantage Medical Group Senior |
$883.03
|
|
|
HC PAPOOSE INFANT SPINAL IMOBLIZR
|
Facility
|
IP
|
$1,038.86
|
|
|
Service Code
|
CPT L0174
|
| Hospital Charge Code |
901606308
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$207.77 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$207.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$467.49
|
| Rate for Payer: Cash Price |
$467.49
|
| Rate for Payer: Cigna of CA HMO |
$727.20
|
| Rate for Payer: Cigna of CA PPO |
$727.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$415.54
|
| Rate for Payer: EPIC Health Plan Senior |
$415.54
|
| Rate for Payer: Galaxy Health WC |
$883.03
|
| Rate for Payer: Global Benefits Group Commercial |
$623.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$692.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$395.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$643.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$249.33
|
| Rate for Payer: Multiplan Commercial |
$831.09
|
| Rate for Payer: Networks By Design Commercial |
$519.43
|
| Rate for Payer: Prime Health Services Commercial |
$883.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.88
|
| Rate for Payer: United Healthcare All Other HMO |
$379.50
|
| Rate for Payer: United Healthcare HMO Rider |
$371.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.23
|
|
|
HC PAP S EAR-THIN PREP PG
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800211
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
|
|
HC PAP S EAR-THIN PREP PG
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 88142
|
| Hospital Charge Code |
903800211
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$139.64 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$139.64
|
| Rate for Payer: Blue Shield of California Commercial |
$39.47
|
| Rate for Payer: Blue Shield of California EPN |
$26.08
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$37.76
|
| Rate for Payer: Cigna of CA PPO |
$43.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.35
|
| Rate for Payer: EPIC Health Plan Senior |
$20.26
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.15
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.41
|
| Rate for Payer: United Healthcare All Other HMO |
$16.41
|
| Rate for Payer: United Healthcare HMO Rider |
$16.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.41
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.29
|
| Rate for Payer: Vantage Medical Group Senior |
$20.26
|
|
|
HC PAP SMEAR-CONVENTIONAL PG
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800212
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$21.25 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
|
|
HC PAP SMEAR-CONVENTIONAL PG
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 88164
|
| Hospital Charge Code |
903800212
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$51.07 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.07
|
| Rate for Payer: Blue Shield of California Commercial |
$16.73
|
| Rate for Payer: Blue Shield of California EPN |
$11.05
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cash Price |
$11.25
|
| Rate for Payer: Cigna of CA HMO |
$16.00
|
| Rate for Payer: Cigna of CA PPO |
$18.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.56
|
| Rate for Payer: EPIC Health Plan Senior |
$18.19
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$29.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$16.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.37
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.01
|
| Rate for Payer: Vantage Medical Group Senior |
$18.19
|
|
|
HC PARACENTESIS EYE RML BLOOD
|
Facility
|
IP
|
$5,924.00
|
|
|
Service Code
|
CPT 65815
|
| Hospital Charge Code |
950442303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,184.80 |
| Max. Negotiated Rate |
$5,035.40 |
| Rate for Payer: Adventist Health Commercial |
$1,184.80
|
| Rate for Payer: Cash Price |
$2,665.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,369.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,369.60
|
| Rate for Payer: Galaxy Health WC |
$5,035.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,554.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,951.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,257.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,666.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,421.76
|
| Rate for Payer: Multiplan Commercial |
$4,739.20
|
| Rate for Payer: Networks By Design Commercial |
$3,850.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,035.40
|
|
|
HC PARACENTESIS EYE RML BLOOD
|
Facility
|
OP
|
$5,924.00
|
|
|
Service Code
|
CPT 65815
|
| Hospital Charge Code |
950442303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$432.92 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,184.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,665.80
|
| Rate for Payer: Cash Price |
$2,665.80
|
| Rate for Payer: Cash Price |
$2,665.80
|
| Rate for Payer: Cigna of CA HMO |
$3,791.36
|
| Rate for Payer: Cigna of CA PPO |
$4,383.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$5,035.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,554.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,951.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,421.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,739.20
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,850.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,035.40
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,554.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,962.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,962.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,962.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,962.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC PARANASAL SINUS LTD
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
909001142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
|
|
HC PARANASAL SINUS LTD
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
909001142
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.32 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$448.64
|
| 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 |
$174.89
|
| Rate for Payer: Blue Shield of California Commercial |
$418.61
|
| Rate for Payer: Blue Shield of California EPN |
$276.34
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO |
$437.76
|
| Rate for Payer: Cigna of CA PPO |
$506.16
|
| 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 |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| 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 |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$410.40
|
| 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 |
$111.88
|
| 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 PARASITE SCREEN
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
900911729
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$62.60 |
| Max. Negotiated Rate |
$266.05 |
| Rate for Payer: Adventist Health Commercial |
$62.60
|
| Rate for Payer: Cash Price |
$140.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.20
|
| Rate for Payer: EPIC Health Plan Senior |
$125.20
|
| Rate for Payer: Galaxy Health WC |
$266.05
|
| Rate for Payer: Global Benefits Group Commercial |
$187.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.12
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: Networks By Design Commercial |
$203.45
|
| Rate for Payer: Prime Health Services Commercial |
$266.05
|
|
