|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
OP
|
$8,306.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,661.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,568.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,229.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: Cigna of CA HMO |
$5,315.84
|
| Rate for Payer: Cigna of CA PPO |
$6,146.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,060.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,060.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,322.40
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,440.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,629.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,141.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,814.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,814.20
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,983.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,060.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,060.10
|
| Rate for Payer: Vantage Medical Group Senior |
$7,060.10
|
|
|
HC PRIM ART M-THROMECTOMY ADD-ON
|
Facility
|
IP
|
$8,306.00
|
|
|
Service Code
|
CPT 37185
|
| Hospital Charge Code |
909081844
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,661.20 |
| Max. Negotiated Rate |
$7,060.10 |
| Rate for Payer: Adventist Health Commercial |
$1,661.20
|
| Rate for Payer: Cash Price |
$3,737.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,322.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,322.40
|
| Rate for Payer: Galaxy Health WC |
$7,060.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,983.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,540.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,164.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,141.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,993.44
|
| Rate for Payer: Multiplan Commercial |
$6,644.80
|
| Rate for Payer: Networks By Design Commercial |
$5,398.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,060.10
|
|
|
HC PRIMOBOOT BARIATRIC PRPL/NAVY
|
Facility
|
IP
|
$297.29
|
|
| Hospital Charge Code |
901698652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Adventist Health Commercial |
$59.46
|
| Rate for Payer: Cash Price |
$133.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.92
|
| Rate for Payer: EPIC Health Plan Senior |
$118.92
|
| Rate for Payer: Galaxy Health WC |
$252.70
|
| Rate for Payer: Global Benefits Group Commercial |
$178.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.35
|
| Rate for Payer: Multiplan Commercial |
$237.83
|
| Rate for Payer: Networks By Design Commercial |
$193.24
|
| Rate for Payer: Prime Health Services Commercial |
$252.70
|
|
|
HC PRIMOBOOT BARIATRIC PRPL/NAVY
|
Facility
|
OP
|
$297.29
|
|
| Hospital Charge Code |
901698652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.46 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Adventist Health Commercial |
$59.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.57
|
| Rate for Payer: Cash Price |
$133.78
|
| Rate for Payer: Cigna of CA HMO |
$190.27
|
| Rate for Payer: Cigna of CA PPO |
$219.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.92
|
| Rate for Payer: EPIC Health Plan Senior |
$118.92
|
| Rate for Payer: Galaxy Health WC |
$252.70
|
| Rate for Payer: Global Benefits Group Commercial |
$178.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$184.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.10
|
| Rate for Payer: Multiplan Commercial |
$237.83
|
| Rate for Payer: Networks By Design Commercial |
$193.24
|
| Rate for Payer: Prime Health Services Commercial |
$252.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.65
|
| Rate for Payer: United Healthcare All Other HMO |
$148.65
|
| Rate for Payer: United Healthcare HMO Rider |
$148.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.70
|
| Rate for Payer: Vantage Medical Group Senior |
$252.70
|
|
|
HC PRIMOBOOT STD PURPLE/NAVY
|
Facility
|
IP
|
$268.17
|
|
| Hospital Charge Code |
901698653
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$227.94 |
| Rate for Payer: Adventist Health Commercial |
$53.63
|
| Rate for Payer: Cash Price |
$120.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.27
|
| Rate for Payer: EPIC Health Plan Senior |
$107.27
|
| Rate for Payer: Galaxy Health WC |
$227.94
|
| Rate for Payer: Global Benefits Group Commercial |
$160.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.36
|
| Rate for Payer: Multiplan Commercial |
$214.54
|
| Rate for Payer: Networks By Design Commercial |
$174.31
|
| Rate for Payer: Prime Health Services Commercial |
$227.94
|
|
|
HC PRIMOBOOT STD PURPLE/NAVY
|
Facility
|
OP
|
$268.17
|
|
| Hospital Charge Code |
901698653
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$53.63 |
| Max. Negotiated Rate |
$227.94 |
| Rate for Payer: Adventist Health Commercial |
$53.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$175.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$164.68
|
| Rate for Payer: Cash Price |
$120.68
|
| Rate for Payer: Cigna of CA HMO |
$171.63
|
| Rate for Payer: Cigna of CA PPO |
$198.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$227.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.27
|
| Rate for Payer: EPIC Health Plan Senior |
$107.27
|
| Rate for Payer: Galaxy Health WC |
$227.94
|
| Rate for Payer: Global Benefits Group Commercial |
$160.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$166.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$187.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$187.72
|
| Rate for Payer: Multiplan Commercial |
$214.54
|
| Rate for Payer: Networks By Design Commercial |
$174.31
|
| Rate for Payer: Prime Health Services Commercial |
$227.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$160.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.09
|
| Rate for Payer: United Healthcare All Other HMO |
$134.09
|
| Rate for Payer: United Healthcare HMO Rider |
$134.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$227.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.94
|
| Rate for Payer: Vantage Medical Group Senior |
$227.94
|
|
|
HC PRIMOBOOT STD W/WEDGE PUR/NAVY
|
Facility
|
OP
|
$297.22
|
|
| Hospital Charge Code |
901698678
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$252.64 |
| Rate for Payer: Adventist Health Commercial |
$59.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$194.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$252.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.52
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: Cigna of CA HMO |
$190.22
|
| Rate for Payer: Cigna of CA PPO |
$219.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$252.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: EPIC Health Plan Senior |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.64
|
| Rate for Payer: Global Benefits Group Commercial |
$178.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$208.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$208.05
|
| Rate for Payer: Multiplan Commercial |
$237.78
|
| Rate for Payer: Networks By Design Commercial |
$193.19
|
| Rate for Payer: Prime Health Services Commercial |
$252.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.61
|
| Rate for Payer: United Healthcare All Other HMO |
$148.61
|
| Rate for Payer: United Healthcare HMO Rider |
$148.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$148.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$252.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.64
|
| Rate for Payer: Vantage Medical Group Senior |
$252.64
|
|
|
HC PRIMOBOOT STD W/WEDGE PUR/NAVY
|
Facility
|
IP
|
$297.22
|
|
| Hospital Charge Code |
901698678
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.44 |
| Max. Negotiated Rate |
$252.64 |
| Rate for Payer: Adventist Health Commercial |
$59.44
|
| Rate for Payer: Cash Price |
$133.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.89
|
| Rate for Payer: EPIC Health Plan Senior |
$118.89
|
| Rate for Payer: Galaxy Health WC |
$252.64
|
| Rate for Payer: Global Benefits Group Commercial |
$178.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$198.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.33
|
| Rate for Payer: Multiplan Commercial |
$237.78
|
| Rate for Payer: Networks By Design Commercial |
$193.19
|
| Rate for Payer: Prime Health Services Commercial |
$252.64
|
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
|
OP
|
$3,599.00
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
900501656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$212.91 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$719.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,619.55
|
| Rate for Payer: Cash Price |
$1,619.55
|
| Rate for Payer: Cash Price |
$1,619.55
|
| Rate for Payer: Cigna of CA HMO |
$2,303.36
|
| Rate for Payer: Cigna of CA PPO |
$2,663.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$3,059.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,159.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,400.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$2,879.20
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$2,339.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,059.15
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,159.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,799.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,799.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,799.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,799.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC PROBE NASOLACRIMAL DUCT W/ANES
|
Facility
|
IP
|
$3,599.00
|
|
|
Service Code
|
CPT 68811
|
| Hospital Charge Code |
900501656
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$719.80 |
| Max. Negotiated Rate |
$3,059.15 |
| Rate for Payer: Adventist Health Commercial |
$719.80
|
| Rate for Payer: Cash Price |
$1,619.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,439.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,439.60
|
| Rate for Payer: Galaxy Health WC |
$3,059.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,159.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,400.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,371.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,227.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$863.76
|
| Rate for Payer: Multiplan Commercial |
$2,879.20
|
| Rate for Payer: Networks By Design Commercial |
$2,339.35
|
| Rate for Payer: Prime Health Services Commercial |
$3,059.15
|
|
|
HC PROBE NASOLACRIMAL DUCT W/TUBE
|
Facility
|
OP
|
$6,346.00
|
|
|
Service Code
|
CPT 68815
|
| Hospital Charge Code |
900501677
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.17 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,269.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,855.70
|
| Rate for Payer: Cash Price |
$2,855.70
|
| Rate for Payer: Cash Price |
$2,855.70
|
| Rate for Payer: Cigna of CA HMO |
$4,061.44
|
| Rate for Payer: Cigna of CA PPO |
$4,696.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$5,394.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,807.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,734.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$5,076.80
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$4,124.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,394.10
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,173.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,173.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,173.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,173.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC PROBE NASOLACRIMAL DUCT W/TUBE
|
Facility
|
IP
|
$6,346.00
|
|
|
Service Code
|
CPT 68815
|
| Hospital Charge Code |
900501677
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,269.20 |
| Max. Negotiated Rate |
$5,394.10 |
| Rate for Payer: Adventist Health Commercial |
$1,269.20
|
| Rate for Payer: Cash Price |
$2,855.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,538.40
|
| Rate for Payer: Galaxy Health WC |
$5,394.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,807.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,232.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,417.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,928.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.04
|
| Rate for Payer: Multiplan Commercial |
$5,076.80
|
| Rate for Payer: Networks By Design Commercial |
$4,124.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,394.10
|
|
|
HC PROB NASOLACRIMAL DUCT
|
Facility
|
IP
|
$2,435.00
|
|
|
Service Code
|
CPT 68810
|
| Hospital Charge Code |
900501582
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$487.00 |
| Max. Negotiated Rate |
$2,069.75 |
| Rate for Payer: Adventist Health Commercial |
$487.00
|
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$974.00
|
| Rate for Payer: EPIC Health Plan Senior |
$974.00
|
| Rate for Payer: Galaxy Health WC |
$2,069.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$927.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,507.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.40
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: Networks By Design Commercial |
$1,582.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,069.75
|
|
|
HC PROB NASOLACRIMAL DUCT
|
Facility
|
OP
|
$2,435.00
|
|
|
Service Code
|
CPT 68810
|
| Hospital Charge Code |
900501582
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$352.98 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$487.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: Cash Price |
$1,095.75
|
| Rate for Payer: Cigna of CA HMO |
$1,558.40
|
| Rate for Payer: Cigna of CA PPO |
$1,801.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$2,069.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,461.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,624.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$584.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$1,948.00
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$1,582.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,069.75
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,217.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,217.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,217.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,217.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC PROB-NATRIURETIC PEPTIDE
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900912306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$556.75 |
| Rate for Payer: Adventist Health Commercial |
$131.00
|
| Rate for Payer: Cash Price |
$294.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.00
|
| Rate for Payer: EPIC Health Plan Senior |
$262.00
|
| Rate for Payer: Galaxy Health WC |
$556.75
|
| Rate for Payer: Global Benefits Group Commercial |
$393.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$436.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$405.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.20
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Networks By Design Commercial |
$425.75
|
| Rate for Payer: Prime Health Services Commercial |
$556.75
|
|
|
HC PROB-NATRIURETIC PEPTIDE
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 83880
|
| Hospital Charge Code |
900912306
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$335.34 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$137.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.34
|
| Rate for Payer: Blue Shield of California Commercial |
$140.49
|
| Rate for Payer: Blue Shield of California EPN |
$92.82
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna of CA HMO |
$134.40
|
| Rate for Payer: Cigna of CA PPO |
$155.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.00
|
| Rate for Payer: EPIC Health Plan Senior |
$39.26
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$64.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$39.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.61
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.80
|
| Rate for Payer: United Healthcare All Other HMO |
$31.80
|
| Rate for Payer: United Healthcare HMO Rider |
$31.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$39.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.19
|
| Rate for Payer: Vantage Medical Group Senior |
$39.26
|
|
|
HC PROCALCITONIN
|
Facility
|
IP
|
$288.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
900912171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.60 |
| Max. Negotiated Rate |
$244.80 |
| Rate for Payer: Adventist Health Commercial |
$57.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Senior |
$115.20
|
| Rate for Payer: Galaxy Health WC |
$244.80
|
| Rate for Payer: Global Benefits Group Commercial |
$172.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.12
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Networks By Design Commercial |
$187.20
|
| Rate for Payer: Prime Health Services Commercial |
$244.80
|
|
|
HC PROCALCITONIN
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT 84145
|
| Hospital Charge Code |
900912171
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.10
|
| Rate for Payer: Blue Shield of California Commercial |
$122.43
|
| Rate for Payer: Blue Shield of California EPN |
$80.89
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Cigna of CA HMO |
$117.12
|
| Rate for Payer: Cigna of CA PPO |
$135.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.75
|
| Rate for Payer: EPIC Health Plan Senior |
$27.22
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$44.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$37.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$36.47
|
| Rate for Payer: Multiplan Commercial |
$146.40
|
| Rate for Payer: Networks By Design Commercial |
$118.95
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.05
|
| Rate for Payer: United Healthcare All Other HMO |
$22.05
|
| Rate for Payer: United Healthcare HMO Rider |
$22.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.94
|
| Rate for Payer: Vantage Medical Group Senior |
$27.22
|
|
|
HC PROC BILIARY TRACT
|
Facility
|
IP
|
$6,066.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
907247999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,213.20 |
| Max. Negotiated Rate |
$5,156.10 |
| Rate for Payer: Adventist Health Commercial |
$1,213.20
|
| Rate for Payer: Cash Price |
$2,729.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,426.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,426.40
|
| Rate for Payer: Galaxy Health WC |
$5,156.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,639.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,046.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,311.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,754.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,455.84
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: Networks By Design Commercial |
$3,942.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,156.10
|
|
|
HC PROC BILIARY TRACT
|
Facility
|
OP
|
$6,066.00
|
|
|
Service Code
|
CPT 47999
|
| Hospital Charge Code |
907247999
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$5,156.10 |
| Rate for Payer: Adventist Health Commercial |
$1,213.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$2,729.70
|
| Rate for Payer: Cash Price |
$2,729.70
|
| Rate for Payer: Cash Price |
$2,729.70
|
| Rate for Payer: Cigna of CA HMO |
$3,882.24
|
| Rate for Payer: Cigna of CA PPO |
$4,488.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$5,156.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,639.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,046.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,455.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,852.80
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,942.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,156.10
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,639.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,033.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,033.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,033.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,033.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
|
IP
|
$5,025.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$4,271.25 |
| Rate for Payer: Adventist Health Commercial |
$1,005.00
|
| Rate for Payer: Cash Price |
$2,261.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,010.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,010.00
|
| Rate for Payer: Galaxy Health WC |
$4,271.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,351.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,110.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$4,020.00
|
| Rate for Payer: Networks By Design Commercial |
$3,266.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,271.25
|
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
|
OP
|
$5,025.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$1,005.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,261.25
|
| Rate for Payer: Cash Price |
$2,261.25
|
| Rate for Payer: Cash Price |
$2,261.25
|
| Rate for Payer: Cigna of CA HMO |
$3,216.00
|
| Rate for Payer: Cigna of CA PPO |
$3,718.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$4,271.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,351.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$4,020.00
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$3,266.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,271.25
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,015.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,512.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,512.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,512.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,512.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
|
OP
|
$5,025.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$295.06 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$1,005.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$2,261.25
|
| Rate for Payer: Cash Price |
$2,261.25
|
| Rate for Payer: Cash Price |
$2,261.25
|
| Rate for Payer: Cigna of CA HMO |
$3,216.00
|
| Rate for Payer: Cigna of CA PPO |
$3,718.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$4,271.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,351.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$371.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$4,020.00
|
| Rate for Payer: Networks By Design Commercial |
$3,266.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,271.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,015.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,015.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC PROC DENTOALVEOLAR STRUCTR
|
Facility
|
IP
|
$5,025.00
|
|
|
Service Code
|
CPT 41899
|
| Hospital Charge Code |
900501221
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,005.00 |
| Max. Negotiated Rate |
$4,271.25 |
| Rate for Payer: Adventist Health Commercial |
$1,005.00
|
| Rate for Payer: Cash Price |
$2,261.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,010.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,010.00
|
| Rate for Payer: Galaxy Health WC |
$4,271.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,015.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,351.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,914.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,110.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$4,020.00
|
| Rate for Payer: Networks By Design Commercial |
$3,266.25
|
| Rate for Payer: Prime Health Services Commercial |
$4,271.25
|
|
|
HC PROCEDURE ANUS
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT 46999
|
| Hospital Charge Code |
900501653
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$230.60 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$230.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cash Price |
$518.85
|
| Rate for Payer: Cigna of CA HMO |
$737.92
|
| Rate for Payer: Cigna of CA PPO |
$853.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$980.05
|
| Rate for Payer: Global Benefits Group Commercial |
$691.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$769.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$276.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$749.45
|
| Rate for Payer: Prime Health Services Commercial |
$980.05
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$691.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$576.50
|
| Rate for Payer: United Healthcare All Other HMO |
$576.50
|
| Rate for Payer: United Healthcare HMO Rider |
$576.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$576.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
