|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
OP
|
$7,426.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$48.79 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,084.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,569.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,369.02
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: Cigna of CA HMO |
$4,826.90
|
| Rate for Payer: Cigna of CA PPO |
$5,495.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,312.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,312.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Galaxy Health WC |
$6,312.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,455.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$48.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,596.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,198.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,198.20
|
| Rate for Payer: Multiplan Commercial |
$5,940.80
|
| Rate for Payer: Networks By Design Commercial |
$4,826.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,455.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,455.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,312.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,312.10
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$7,426.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906811431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,485.20 |
| Max. Negotiated Rate |
$6,312.10 |
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Galaxy Health WC |
$6,312.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,455.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,829.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,596.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.24
|
| Rate for Payer: Multiplan Commercial |
$5,940.80
|
| Rate for Payer: Networks By Design Commercial |
$4,826.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.10
|
|
|
HC REPOSITION VAD DIFF SESSION
|
Facility
|
IP
|
$7,217.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
906820234
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,443.40 |
| Max. Negotiated Rate |
$6,134.45 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,886.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,886.80
|
| Rate for Payer: Galaxy Health WC |
$6,134.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,330.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,749.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,467.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,732.08
|
| Rate for Payer: Multiplan Commercial |
$5,773.60
|
| Rate for Payer: Networks By Design Commercial |
$4,691.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,134.45
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
OP
|
$11,311.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$881.39 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$2,262.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$6,221.05
|
| Rate for Payer: Cash Price |
$6,221.05
|
| Rate for Payer: Cash Price |
$6,221.05
|
| Rate for Payer: Cigna of CA HMO |
$7,239.04
|
| Rate for Payer: Cigna of CA PPO |
$8,370.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$9,614.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,786.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,544.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$881.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,714.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$9,048.80
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$7,352.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,614.35
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,786.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,655.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,655.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,655.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,655.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC REP PRIM, RUPTRD ACHILLES TEND
|
Facility
|
IP
|
$11,311.00
|
|
|
Service Code
|
CPT 27650
|
| Hospital Charge Code |
900501585
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,262.20 |
| Max. Negotiated Rate |
$9,614.35 |
| Rate for Payer: Adventist Health Commercial |
$2,262.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,347.52
|
| Rate for Payer: Blue Shield of California EPN |
$5,497.15
|
| Rate for Payer: Cash Price |
$6,221.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,524.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,524.40
|
| Rate for Payer: Galaxy Health WC |
$9,614.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,786.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,544.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,309.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,001.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,714.64
|
| Rate for Payer: Multiplan Commercial |
$9,048.80
|
| Rate for Payer: Networks By Design Commercial |
$7,352.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,614.35
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
IP
|
$5,567.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,113.40 |
| Max. Negotiated Rate |
$4,731.95 |
| Rate for Payer: Adventist Health Commercial |
$1,113.40
|
| Rate for Payer: Cash Price |
$3,061.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,226.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,226.80
|
| Rate for Payer: Galaxy Health WC |
$4,731.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,713.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,121.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,445.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.08
|
| Rate for Payer: Multiplan Commercial |
$4,453.60
|
| Rate for Payer: Networks By Design Commercial |
$3,618.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,731.95
|
|
|
HC REPR DETACHED RETINA BY INJ
|
Facility
|
OP
|
$5,567.00
|
|
|
Service Code
|
CPT 67110
|
| Hospital Charge Code |
900501721
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$6,427.00 |
| Rate for Payer: Adventist Health Commercial |
$1,113.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$3,061.85
|
| Rate for Payer: Cash Price |
$3,061.85
|
| Rate for Payer: Cash Price |
$3,061.85
|
| Rate for Payer: Cigna of CA HMO |
$3,562.88
|
| Rate for Payer: Cigna of CA PPO |
$4,119.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$4,731.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,340.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,713.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,453.60
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,618.55
|
| Rate for Payer: Prime Health Services Commercial |
$4,731.95
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,340.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,783.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,783.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,783.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,783.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
OP
|
$4,462.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$713.03 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$892.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,454.10
|
| Rate for Payer: Cash Price |
$2,454.10
|
| Rate for Payer: Cash Price |
$2,454.10
|
| Rate for Payer: Cigna of CA HMO |
$2,855.68
|
| Rate for Payer: Cigna of CA PPO |
$3,301.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$3,792.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,976.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$713.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,371.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$3,569.60
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,900.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,792.70
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,677.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,231.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,231.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,231.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC REPR F/THICK VERM LAC, GT 1/2 VE
|
Facility
|
IP
|
$4,462.00
|
|
|
Service Code
|
CPT 40654
|
| Hospital Charge Code |
900501145
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$892.40 |
| Max. Negotiated Rate |
$3,792.70 |
| Rate for Payer: Adventist Health Commercial |
$892.40
|
| Rate for Payer: Cash Price |
$2,454.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,784.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,784.80
|
| Rate for Payer: Galaxy Health WC |
$3,792.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,677.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,976.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,761.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,070.88
|
| Rate for Payer: Multiplan Commercial |
$3,569.60
|
| Rate for Payer: Networks By Design Commercial |
$2,900.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,792.70
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$740.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$148.00 |
| Max. Negotiated Rate |
$629.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.00
|
| Rate for Payer: EPIC Health Plan Senior |
$296.00
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
OP
|
$740.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$148.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cash Price |
$407.00
|
| Rate for Payer: Cigna of CA HMO |
$473.60
|
| Rate for Payer: Cigna of CA PPO |
$547.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.44
|
| Rate for Payer: EPIC Health Plan Senior |
$381.07
|
| Rate for Payer: Galaxy Health WC |
$629.00
|
| Rate for Payer: Global Benefits Group Commercial |
$444.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$624.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$381.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$493.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$480.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.63
|
| Rate for Payer: Multiplan Commercial |
$592.00
|
| Rate for Payer: Multiplan WC |
$607.16
|
| Rate for Payer: Networks By Design Commercial |
$481.00
|
| Rate for Payer: Prime Health Services Commercial |
$629.00
|
| Rate for Payer: Prime Health Services WC |
$600.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.00
|
| Rate for Payer: United Healthcare All Other HMO |
$370.00
|
| Rate for Payer: United Healthcare HMO Rider |
$370.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$381.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Vantage Medical Group Senior |
$381.07
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
OP
|
$992.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.40 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: Cigna of CA HMO |
$634.88
|
| Rate for Payer: Cigna of CA PPO |
$734.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$595.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$496.00
|
| Rate for Payer: United Healthcare All Other HMO |
$496.00
|
| Rate for Payer: United Healthcare HMO Rider |
$496.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$496.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.40 |
| Max. Negotiated Rate |
$843.20 |
| Rate for Payer: Adventist Health Commercial |
$198.40
|
| Rate for Payer: Cash Price |
$545.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.80
|
| Rate for Payer: EPIC Health Plan Senior |
$396.80
|
| Rate for Payer: Galaxy Health WC |
$843.20
|
| Rate for Payer: Global Benefits Group Commercial |
$595.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$661.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$614.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.08
|
| Rate for Payer: Multiplan Commercial |
$793.60
|
| Rate for Payer: Networks By Design Commercial |
$644.80
|
| Rate for Payer: Prime Health Services Commercial |
$843.20
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
OP
|
$4,257.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$851.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$2,341.35
|
| Rate for Payer: Cash Price |
$2,341.35
|
| Rate for Payer: Cash Price |
$2,341.35
|
| Rate for Payer: Cigna of CA HMO |
$2,724.48
|
| Rate for Payer: Cigna of CA PPO |
$3,150.18
|
| 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 |
$3,618.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.20
|
| 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 |
$2,839.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.68
|
| 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 |
$3,405.60
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$2,767.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,618.45
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,554.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,128.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,128.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,128.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,128.50
|
| 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 REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
IP
|
$4,257.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$851.40 |
| Max. Negotiated Rate |
$3,618.45 |
| Rate for Payer: Adventist Health Commercial |
$851.40
|
| Rate for Payer: Cash Price |
$2,341.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,702.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,702.80
|
| Rate for Payer: Galaxy Health WC |
$3,618.45
|
| Rate for Payer: Global Benefits Group Commercial |
$2,554.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,839.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,621.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,635.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.68
|
| Rate for Payer: Multiplan Commercial |
$3,405.60
|
| Rate for Payer: Networks By Design Commercial |
$2,767.05
|
| Rate for Payer: Prime Health Services Commercial |
$3,618.45
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
IP
|
$1,322.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$264.40 |
| Max. Negotiated Rate |
$1,123.70 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Cash Price |
$727.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$528.80
|
| Rate for Payer: EPIC Health Plan Senior |
$528.80
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$503.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$818.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
OP
|
$1,322.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$264.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$727.10
|
| Rate for Payer: Cash Price |
$727.10
|
| Rate for Payer: Cash Price |
$727.10
|
| Rate for Payer: Cigna of CA HMO |
$846.08
|
| Rate for Payer: Cigna of CA PPO |
$978.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,123.70
|
| Rate for Payer: Global Benefits Group Commercial |
$793.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$881.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$317.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$638.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$859.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,123.70
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$793.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$661.00
|
| Rate for Payer: United Healthcare All Other HMO |
$661.00
|
| Rate for Payer: United Healthcare HMO Rider |
$661.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$661.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
IP
|
$7,972.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,594.40 |
| Max. Negotiated Rate |
$6,776.20 |
| Rate for Payer: Adventist Health Commercial |
$1,594.40
|
| Rate for Payer: Cash Price |
$4,384.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,188.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,188.80
|
| Rate for Payer: Galaxy Health WC |
$6,776.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,037.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,934.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.28
|
| Rate for Payer: Multiplan Commercial |
$6,377.60
|
| Rate for Payer: Networks By Design Commercial |
$5,181.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,776.20
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
OP
|
$7,972.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$710.20 |
| Max. Negotiated Rate |
$12,491.00 |
| Rate for Payer: Adventist Health Commercial |
$1,594.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Cash Price |
$4,384.60
|
| Rate for Payer: Cash Price |
$4,384.60
|
| Rate for Payer: Cash Price |
$4,384.60
|
| Rate for Payer: Cigna of CA HMO |
$5,102.08
|
| Rate for Payer: Cigna of CA PPO |
$5,899.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$6,776.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,783.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,317.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,913.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$6,377.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,181.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,776.20
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,783.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,986.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,986.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,986.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,986.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC RESEARCH CLINIC VISIT
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC RESEARCH CLINIC VISIT
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.74
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$20.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$185.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$185.50
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC RESECTION/DEBRID PANCREAS
|
Facility
|
OP
|
$7,450.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,490.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,490.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,332.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,097.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,587.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,097.50
|
| Rate for Payer: Cash Price |
$4,097.50
|
| Rate for Payer: Cash Price |
$4,097.50
|
| Rate for Payer: Cigna of CA HMO |
$4,768.00
|
| Rate for Payer: Cigna of CA PPO |
$5,513.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,332.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,332.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,332.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,980.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,980.00
|
| Rate for Payer: Galaxy Health WC |
$6,332.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,470.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,740.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,969.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,230.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,611.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,788.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,215.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,215.00
|
| Rate for Payer: Multiplan Commercial |
$5,960.00
|
| Rate for Payer: Networks By Design Commercial |
$4,842.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,332.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,470.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,470.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,332.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,332.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6,332.50
|
|
|
HC RESECTION/DEBRID PANCREAS
|
Facility
|
IP
|
$7,450.00
|
|
|
Service Code
|
CPT 48105
|
| Hospital Charge Code |
906748105
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,490.00 |
| Max. Negotiated Rate |
$6,332.50 |
| Rate for Payer: Adventist Health Commercial |
$1,490.00
|
| Rate for Payer: Cash Price |
$4,097.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,980.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,980.00
|
| Rate for Payer: Galaxy Health WC |
$6,332.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,470.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,969.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,838.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,611.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,788.00
|
| Rate for Payer: Multiplan Commercial |
$5,960.00
|
| Rate for Payer: Networks By Design Commercial |
$4,842.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,332.50
|
|
|
HC RESPIRATOR W/STRAP PEDS SZ 3
|
Facility
|
IP
|
$231.70
|
|
| Hospital Charge Code |
901698719
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$196.94 |
| Rate for Payer: Adventist Health Commercial |
$46.34
|
| Rate for Payer: Cash Price |
$127.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.68
|
| Rate for Payer: EPIC Health Plan Senior |
$92.68
|
| Rate for Payer: Galaxy Health WC |
$196.94
|
| Rate for Payer: Global Benefits Group Commercial |
$139.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.61
|
| Rate for Payer: Multiplan Commercial |
$185.36
|
| Rate for Payer: Networks By Design Commercial |
$150.60
|
| Rate for Payer: Prime Health Services Commercial |
$196.94
|
|
|
HC RESPIRATOR W/STRAP PEDS SZ 3
|
Facility
|
OP
|
$231.70
|
|
| Hospital Charge Code |
901698719
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.34 |
| Max. Negotiated Rate |
$196.94 |
| Rate for Payer: Adventist Health Commercial |
$46.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.29
|
| Rate for Payer: Cash Price |
$127.44
|
| Rate for Payer: Cigna of CA HMO |
$148.29
|
| Rate for Payer: Cigna of CA PPO |
$171.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.68
|
| Rate for Payer: EPIC Health Plan Senior |
$92.68
|
| Rate for Payer: Galaxy Health WC |
$196.94
|
| Rate for Payer: Global Benefits Group Commercial |
$139.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.19
|
| Rate for Payer: Multiplan Commercial |
$185.36
|
| Rate for Payer: Networks By Design Commercial |
$150.60
|
| Rate for Payer: Prime Health Services Commercial |
$196.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.85
|
| Rate for Payer: United Healthcare All Other HMO |
$115.85
|
| Rate for Payer: United Healthcare HMO Rider |
$115.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.94
|
| Rate for Payer: Vantage Medical Group Senior |
$196.94
|
|
