|
HC PROC SK MUC MEMB & SUB
|
Facility
|
OP
|
$1,388.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
900501051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$252.47 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$277.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$763.40
|
| Rate for Payer: Cash Price |
$763.40
|
| Rate for Payer: Cash Price |
$763.40
|
| Rate for Payer: Cigna of CA HMO |
$888.32
|
| Rate for Payer: Cigna of CA PPO |
$1,027.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$902.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$832.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$694.00
|
| Rate for Payer: United Healthcare All Other HMO |
$694.00
|
| Rate for Payer: United Healthcare HMO Rider |
$694.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$694.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC PROC SK MUC MEMB & SUB
|
Facility
|
IP
|
$1,388.00
|
|
|
Service Code
|
CPT 17999
|
| Hospital Charge Code |
900501051
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$277.60 |
| Max. Negotiated Rate |
$1,179.80 |
| Rate for Payer: Adventist Health Commercial |
$277.60
|
| Rate for Payer: Cash Price |
$763.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$555.20
|
| Rate for Payer: EPIC Health Plan Senior |
$555.20
|
| Rate for Payer: Galaxy Health WC |
$1,179.80
|
| Rate for Payer: Global Benefits Group Commercial |
$832.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$925.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$528.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$859.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$333.12
|
| Rate for Payer: Multiplan Commercial |
$1,110.40
|
| Rate for Payer: Networks By Design Commercial |
$902.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,179.80
|
|
|
HC PROCTOSIGMODISOCPY W REMOVAL
|
Facility
|
IP
|
$2,474.00
|
|
|
Service Code
|
CPT 45309
|
| Hospital Charge Code |
906745309
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$494.80 |
| Max. Negotiated Rate |
$2,102.90 |
| Rate for Payer: Adventist Health Commercial |
$494.80
|
| Rate for Payer: Cash Price |
$1,360.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$989.60
|
| Rate for Payer: EPIC Health Plan Senior |
$989.60
|
| Rate for Payer: Galaxy Health WC |
$2,102.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,484.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,650.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$942.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,531.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.76
|
| Rate for Payer: Multiplan Commercial |
$1,979.20
|
| Rate for Payer: Networks By Design Commercial |
$1,608.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,102.90
|
|
|
HC PROCTOSIGMODISOCPY W REMOVAL
|
Facility
|
OP
|
$2,474.00
|
|
|
Service Code
|
CPT 45309
|
| Hospital Charge Code |
906745309
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$494.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| 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 |
$1,360.70
|
| Rate for Payer: Cash Price |
$1,360.70
|
| Rate for Payer: Cash Price |
$1,360.70
|
| Rate for Payer: Cigna of CA HMO |
$1,583.36
|
| Rate for Payer: Cigna of CA PPO |
$1,830.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$2,102.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,484.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$165.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,650.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$186.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$593.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$1,979.20
|
| Rate for Payer: Networks By Design Commercial |
$1,608.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,102.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,484.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| 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 |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC PROCTOSIGMOIDOSCOPY RIGID/DIL
|
Facility
|
IP
|
$2,277.00
|
|
|
Service Code
|
CPT 45303
|
| Hospital Charge Code |
906745303
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$455.40 |
| Max. Negotiated Rate |
$1,935.45 |
| Rate for Payer: Adventist Health Commercial |
$455.40
|
| Rate for Payer: Cash Price |
$1,252.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.80
|
| Rate for Payer: EPIC Health Plan Senior |
$910.80
|
| Rate for Payer: Galaxy Health WC |
$1,935.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,518.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.48
|
| Rate for Payer: Multiplan Commercial |
$1,821.60
|
| Rate for Payer: Networks By Design Commercial |
$1,480.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,935.45
|
|
|
HC PROCTOSIGMOIDOSCOPY RIGID/DIL
|
Facility
|
OP
|
$2,277.00
|
|
|
Service Code
|
CPT 45303
|
| Hospital Charge Code |
906745303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$455.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| 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 |
$1,252.35
|
| Rate for Payer: Cash Price |
$1,252.35
|
| Rate for Payer: Cash Price |
$1,252.35
|
| Rate for Payer: Cigna of CA HMO |
$1,457.28
|
| Rate for Payer: Cigna of CA PPO |
$1,684.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$1,935.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,518.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$1,821.60
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$1,480.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,935.45
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,366.20
|
| 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 |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC PROCTOSIGMOIDOSCOPY RIGID/DIL
|
Facility
|
OP
|
$2,277.00
|
|
|
Service Code
|
CPT 45303
|
| Hospital Charge Code |
906745303
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$455.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| 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 |
$1,252.35
|
| Rate for Payer: Cash Price |
$1,252.35
|
| Rate for Payer: Cash Price |
$1,252.35
|
| Rate for Payer: Cigna of CA HMO |
$1,457.28
|
| Rate for Payer: Cigna of CA PPO |
$1,684.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$1,935.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,518.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$1,821.60
|
| Rate for Payer: Networks By Design Commercial |
$1,480.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,935.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,366.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| 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 |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC PROCTOSIGMOIDOSCOPY RIGID/DIL
|
Facility
|
IP
|
$2,277.00
|
|
|
Service Code
|
CPT 45303
|
| Hospital Charge Code |
906745303
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$455.40 |
| Max. Negotiated Rate |
$1,935.45 |
| Rate for Payer: Adventist Health Commercial |
$455.40
|
| Rate for Payer: Cash Price |
$1,252.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.80
|
| Rate for Payer: EPIC Health Plan Senior |
$910.80
|
| Rate for Payer: Galaxy Health WC |
$1,935.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,366.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,518.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$546.48
|
| Rate for Payer: Multiplan Commercial |
$1,821.60
|
| Rate for Payer: Networks By Design Commercial |
$1,480.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,935.45
|
|
|
HC PROCTOSIGMOIDOSCOPY W FB RMVL
|
Facility
|
IP
|
$6,630.00
|
|
|
Service Code
|
CPT 45307
|
| Hospital Charge Code |
906745307
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,326.00 |
| Max. Negotiated Rate |
$5,635.50 |
| Rate for Payer: Adventist Health Commercial |
$1,326.00
|
| Rate for Payer: Cash Price |
$3,646.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,652.00
|
| Rate for Payer: Galaxy Health WC |
$5,635.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,978.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,422.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,526.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,103.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,591.20
|
| Rate for Payer: Multiplan Commercial |
$5,304.00
|
| Rate for Payer: Networks By Design Commercial |
$4,309.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,635.50
|
|
|
HC PROCTOSIGMOIDOSCOPY W FB RMVL
|
Facility
|
OP
|
$6,630.00
|
|
|
Service Code
|
CPT 45307
|
| Hospital Charge Code |
906745307
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$130.10 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,326.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| 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 |
$3,646.50
|
| Rate for Payer: Cash Price |
$3,646.50
|
| Rate for Payer: Cash Price |
$3,646.50
|
| Rate for Payer: Cigna of CA HMO |
$4,243.20
|
| Rate for Payer: Cigna of CA PPO |
$4,906.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,704.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.48
|
| Rate for Payer: Galaxy Health WC |
$5,635.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,978.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,714.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$130.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,422.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,591.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,669.20
|
| Rate for Payer: Multiplan Commercial |
$5,304.00
|
| Rate for Payer: Networks By Design Commercial |
$4,309.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,635.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,978.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,181.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,484.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
OP
|
$4,840.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
900501380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$68.61 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$968.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,662.00
|
| Rate for Payer: Cash Price |
$2,662.00
|
| Rate for Payer: Cash Price |
$2,662.00
|
| Rate for Payer: Cigna of CA HMO |
$3,097.60
|
| Rate for Payer: Cigna of CA PPO |
$3,581.60
|
| 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 |
$4,114.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.00
|
| 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 |
$3,228.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| 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 |
$3,872.00
|
| Rate for Payer: Multiplan WC |
$1,845.73
|
| Rate for Payer: Networks By Design Commercial |
$3,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.00
|
| Rate for Payer: Prime Health Services WC |
$1,826.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,904.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,420.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,420.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,420.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,420.00
|
| 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
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
IP
|
$4,840.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
900501380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$968.00 |
| Max. Negotiated Rate |
$4,114.00 |
| Rate for Payer: Adventist Health Commercial |
$968.00
|
| Rate for Payer: Cash Price |
$2,662.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,936.00
|
| Rate for Payer: Galaxy Health WC |
$4,114.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,228.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,844.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,995.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Multiplan Commercial |
$3,872.00
|
| Rate for Payer: Networks By Design Commercial |
$3,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.00
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
OP
|
$4,840.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
906745300
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$60.66 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$968.00
|
| 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 |
$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 |
$2,662.00
|
| Rate for Payer: Cash Price |
$2,662.00
|
| Rate for Payer: Cash Price |
$2,662.00
|
| Rate for Payer: Cigna of CA HMO |
$3,097.60
|
| Rate for Payer: Cigna of CA PPO |
$3,581.60
|
| 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 |
$4,114.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,228.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| 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 |
$3,872.00
|
| Rate for Payer: Networks By Design Commercial |
$3,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,904.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| 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 |
$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
|
|
|
HC PROCTOSIGMOIDOSCOPY W WO COLL
|
Facility
|
IP
|
$4,840.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
906745300
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$968.00 |
| Max. Negotiated Rate |
$4,114.00 |
| Rate for Payer: Adventist Health Commercial |
$968.00
|
| Rate for Payer: Cash Price |
$2,662.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,936.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,936.00
|
| Rate for Payer: Galaxy Health WC |
$4,114.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,228.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,844.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,995.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.60
|
| Rate for Payer: Multiplan Commercial |
$3,872.00
|
| Rate for Payer: Networks By Design Commercial |
$3,146.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.00
|
|
|
HC PROCTOSIGMOIDOSCPY RIG W/BX
|
Facility
|
IP
|
$2,071.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
906745305
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$414.20 |
| Max. Negotiated Rate |
$1,760.35 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.40
|
| Rate for Payer: EPIC Health Plan Senior |
$828.40
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$789.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
|
|
HC PROCTOSIGMOIDOSCPY RIG W/BX
|
Facility
|
OP
|
$2,071.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
906745305
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$85.06 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$414.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| 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 |
$1,139.05
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Cash Price |
$1,139.05
|
| Rate for Payer: Cigna of CA HMO |
$1,325.44
|
| Rate for Payer: Cigna of CA PPO |
$1,532.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$1,760.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$85.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,381.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$497.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$1,656.80
|
| Rate for Payer: Networks By Design Commercial |
$1,346.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,760.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| 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 |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
OP
|
$4,688.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$5,714.55 |
| Rate for Payer: Adventist Health Commercial |
$937.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,578.40
|
| Rate for Payer: Cash Price |
$2,578.40
|
| Rate for Payer: Cash Price |
$2,578.40
|
| Rate for Payer: Cigna of CA HMO |
$3,000.32
|
| Rate for Payer: Cigna of CA PPO |
$3,469.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,704.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.48
|
| Rate for Payer: Galaxy Health WC |
$3,984.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,714.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,126.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,390.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,669.20
|
| Rate for Payer: Multiplan Commercial |
$3,750.40
|
| Rate for Payer: Multiplan WC |
$5,551.91
|
| Rate for Payer: Networks By Design Commercial |
$3,047.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,984.80
|
| Rate for Payer: Prime Health Services WC |
$5,495.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,812.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,344.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,344.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,344.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,344.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,484.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
HC PROCTOSIGMOIDOSCPY W DECOM
|
Facility
|
IP
|
$4,688.00
|
|
|
Service Code
|
CPT 45321
|
| Hospital Charge Code |
900501352
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$937.60 |
| Max. Negotiated Rate |
$3,984.80 |
| Rate for Payer: Adventist Health Commercial |
$937.60
|
| Rate for Payer: Cash Price |
$2,578.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,875.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,875.20
|
| Rate for Payer: Galaxy Health WC |
$3,984.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,812.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,126.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,786.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,901.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.12
|
| Rate for Payer: Multiplan Commercial |
$3,750.40
|
| Rate for Payer: Networks By Design Commercial |
$3,047.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,984.80
|
|
|
HC PROGESTERONE
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.89 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.07
|
| Rate for Payer: Blue Shield of California Commercial |
$167.25
|
| Rate for Payer: Blue Shield of California EPN |
$110.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cigna of CA HMO |
$160.00
|
| Rate for Payer: Cigna of CA PPO |
$185.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.16
|
| Rate for Payer: EPIC Health Plan Senior |
$20.86
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.95
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.89
|
| Rate for Payer: United Healthcare All Other HMO |
$16.89
|
| Rate for Payer: United Healthcare HMO Rider |
$16.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.89
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.95
|
| Rate for Payer: Vantage Medical Group Senior |
$20.86
|
|
|
HC PROGESTERONE
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
900912132
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
|
|
HC PROLACTIN
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.00
|
| Rate for Payer: EPIC Health Plan Senior |
$176.00
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
|
|
HC PROLACTIN
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
900910808
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.70 |
| Max. Negotiated Rate |
$374.00 |
| Rate for Payer: Adventist Health Commercial |
$88.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$191.38
|
| Rate for Payer: Blue Shield of California Commercial |
$294.36
|
| Rate for Payer: Blue Shield of California EPN |
$194.48
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cash Price |
$242.00
|
| Rate for Payer: Cigna of CA HMO |
$281.60
|
| Rate for Payer: Cigna of CA PPO |
$325.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.16
|
| Rate for Payer: EPIC Health Plan Senior |
$19.38
|
| Rate for Payer: Galaxy Health WC |
$374.00
|
| Rate for Payer: Global Benefits Group Commercial |
$264.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$31.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$28.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$19.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$293.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.97
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Networks By Design Commercial |
$286.00
|
| Rate for Payer: Prime Health Services Commercial |
$374.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.70
|
| Rate for Payer: United Healthcare All Other HMO |
$15.70
|
| Rate for Payer: United Healthcare HMO Rider |
$15.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$19.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.32
|
| Rate for Payer: Vantage Medical Group Senior |
$19.38
|
|
|
HC PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
OP
|
$791.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$158.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$6,427.00
|
| Rate for Payer: Cash Price |
$435.05
|
| Rate for Payer: Cash Price |
$435.05
|
| Rate for Payer: Cash Price |
$435.05
|
| Rate for Payer: Cigna of CA HMO |
$506.24
|
| Rate for Payer: Cigna of CA PPO |
$585.34
|
| 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 |
$672.35
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| 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 |
$527.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.84
|
| 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 |
$632.80
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$474.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$395.50
|
| Rate for Payer: United Healthcare All Other HMO |
$395.50
|
| Rate for Payer: United Healthcare HMO Rider |
$395.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$395.50
|
| 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 PROPHYLAXIS OF RETINAL DETCHMNT
|
Facility
|
IP
|
$791.00
|
|
|
Service Code
|
CPT 67141
|
| Hospital Charge Code |
900567141
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$672.35 |
| Rate for Payer: Adventist Health Commercial |
$158.20
|
| Rate for Payer: Cash Price |
$435.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$316.40
|
| Rate for Payer: EPIC Health Plan Senior |
$316.40
|
| Rate for Payer: Galaxy Health WC |
$672.35
|
| Rate for Payer: Global Benefits Group Commercial |
$474.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$527.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$301.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$489.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$189.84
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: Networks By Design Commercial |
$514.15
|
| Rate for Payer: Prime Health Services Commercial |
$672.35
|
|
|
HC PROPORT CNTR 12 VOLT UTAH
|
Facility
|
IP
|
$18,471.00
|
|
|
Service Code
|
CPT L7274
|
| Hospital Charge Code |
905357274
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,694.20 |
| Max. Negotiated Rate |
$15,700.35 |
| Rate for Payer: Adventist Health Commercial |
$3,694.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$10,159.05
|
| Rate for Payer: Cash Price |
$10,159.05
|
| Rate for Payer: Cigna of CA HMO |
$12,929.70
|
| Rate for Payer: Cigna of CA PPO |
$12,929.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$7,388.40
|
| Rate for Payer: Galaxy Health WC |
$15,700.35
|
| Rate for Payer: Global Benefits Group Commercial |
$11,082.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,320.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,037.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,433.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,433.04
|
| Rate for Payer: Multiplan Commercial |
$14,776.80
|
| Rate for Payer: Networks By Design Commercial |
$9,235.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,700.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,932.17
|
| Rate for Payer: United Healthcare All Other HMO |
$6,747.46
|
| Rate for Payer: United Healthcare HMO Rider |
$6,601.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,049.25
|
|
