|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
905353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$60.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.72
|
| Rate for Payer: Blue Shield of California Commercial |
$109.22
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103.60
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.80
|
| Rate for Payer: Vantage Medical Group Senior |
$125.80
|
|
|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
905353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
|
|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
915353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
|
|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
915353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$125.80 |
| Rate for Payer: Adventist Health Commercial |
$60.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.72
|
| Rate for Payer: Blue Shield of California Commercial |
$109.22
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$103.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$103.60
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.80
|
| Rate for Payer: Vantage Medical Group Senior |
$125.80
|
|
|
HC SHTH PERCUTANEOUS 6FR
|
Facility
|
IP
|
$232.40
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$197.54 |
| Rate for Payer: Adventist Health Commercial |
$46.48
|
| Rate for Payer: Cash Price |
$104.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.96
|
| Rate for Payer: EPIC Health Plan Senior |
$92.96
|
| Rate for Payer: Galaxy Health WC |
$197.54
|
| Rate for Payer: Global Benefits Group Commercial |
$139.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.78
|
| Rate for Payer: Multiplan Commercial |
$185.92
|
| Rate for Payer: Networks By Design Commercial |
$151.06
|
| Rate for Payer: Prime Health Services Commercial |
$197.54
|
|
|
HC SHTH PERCUTANEOUS 6FR
|
Facility
|
OP
|
$232.40
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$197.54 |
| Rate for Payer: Adventist Health Commercial |
$46.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.72
|
| Rate for Payer: Cash Price |
$104.58
|
| Rate for Payer: Cigna of CA HMO |
$148.74
|
| Rate for Payer: Cigna of CA PPO |
$171.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.96
|
| Rate for Payer: EPIC Health Plan Senior |
$92.96
|
| Rate for Payer: Galaxy Health WC |
$197.54
|
| Rate for Payer: Global Benefits Group Commercial |
$139.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.68
|
| Rate for Payer: Multiplan Commercial |
$185.92
|
| Rate for Payer: Networks By Design Commercial |
$151.06
|
| Rate for Payer: Prime Health Services Commercial |
$197.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.20
|
| Rate for Payer: United Healthcare All Other HMO |
$116.20
|
| Rate for Payer: United Healthcare HMO Rider |
$116.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.54
|
| Rate for Payer: Vantage Medical Group Senior |
$197.54
|
|
|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
|
IP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Adventist Health Commercial |
$43.08
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: EPIC Health Plan Senior |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.69
|
| Rate for Payer: Multiplan Commercial |
$172.31
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
|
|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
|
OP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Adventist Health Commercial |
$43.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.27
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Cigna of CA HMO |
$137.85
|
| Rate for Payer: Cigna of CA PPO |
$159.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: EPIC Health Plan Senior |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$150.77
|
| Rate for Payer: Multiplan Commercial |
$172.31
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.69
|
| Rate for Payer: United Healthcare All Other HMO |
$107.69
|
| Rate for Payer: United Healthcare HMO Rider |
$107.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.08
|
| Rate for Payer: Vantage Medical Group Senior |
$183.08
|
|
|
HC SHTH PERCUTANEOUS INTRO 8.5FR
|
Facility
|
OP
|
$348.60
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$296.31 |
| Rate for Payer: Adventist Health Commercial |
$69.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$228.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.08
|
| Rate for Payer: Cash Price |
$156.87
|
| Rate for Payer: Cigna of CA HMO |
$223.10
|
| Rate for Payer: Cigna of CA PPO |
$257.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$296.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$296.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Senior |
$139.44
|
| Rate for Payer: Galaxy Health WC |
$296.31
|
| Rate for Payer: Global Benefits Group Commercial |
$209.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$244.02
|
| Rate for Payer: Multiplan Commercial |
$278.88
|
| Rate for Payer: Networks By Design Commercial |
$226.59
|
| Rate for Payer: Prime Health Services Commercial |
$296.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.30
|
| Rate for Payer: United Healthcare All Other HMO |
$174.30
|
| Rate for Payer: United Healthcare HMO Rider |
$174.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.31
|
| Rate for Payer: Vantage Medical Group Senior |
$296.31
|
|
|
HC SHTH PERCUTANEOUS INTRO 8.5FR
|
Facility
|
IP
|
$348.60
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$296.31 |
| Rate for Payer: Adventist Health Commercial |
$69.72
|
| Rate for Payer: Cash Price |
$156.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Senior |
$139.44
|
| Rate for Payer: Galaxy Health WC |
$296.31
|
| Rate for Payer: Global Benefits Group Commercial |
$209.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.66
|
| Rate for Payer: Multiplan Commercial |
$278.88
|
| Rate for Payer: Networks By Design Commercial |
$226.59
|
| Rate for Payer: Prime Health Services Commercial |
$296.31
|
|
|
HC SHTH PER-Q 8.5FR X 10CM BRK
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$237.41 |
| Rate for Payer: Adventist Health Commercial |
$55.86
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.72
|
| Rate for Payer: EPIC Health Plan Senior |
$111.72
|
| Rate for Payer: Galaxy Health WC |
$237.41
|
| Rate for Payer: Global Benefits Group Commercial |
$167.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.03
|
| Rate for Payer: Multiplan Commercial |
$223.44
|
| Rate for Payer: Networks By Design Commercial |
$181.54
|
| Rate for Payer: Prime Health Services Commercial |
$237.41
|
|
|
HC SHTH PER-Q 8.5FR X 10CM BRK
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$237.41 |
| Rate for Payer: Adventist Health Commercial |
$55.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.52
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cigna of CA HMO |
$178.75
|
| Rate for Payer: Cigna of CA PPO |
$206.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$237.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$237.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.72
|
| Rate for Payer: EPIC Health Plan Senior |
$111.72
|
| Rate for Payer: Galaxy Health WC |
$237.41
|
| Rate for Payer: Global Benefits Group Commercial |
$167.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$195.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$195.51
|
| Rate for Payer: Multiplan Commercial |
$223.44
|
| Rate for Payer: Networks By Design Commercial |
$181.54
|
| Rate for Payer: Prime Health Services Commercial |
$237.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$167.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$167.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.65
|
| Rate for Payer: United Healthcare All Other HMO |
$139.65
|
| Rate for Payer: United Healthcare HMO Rider |
$139.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$237.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.41
|
| Rate for Payer: Vantage Medical Group Senior |
$237.41
|
|
|
HC SHUNT EVALUATION
|
Facility
|
OP
|
$2,411.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$250.92 |
| Max. Negotiated Rate |
$2,049.35 |
| Rate for Payer: Adventist Health Commercial |
$482.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,581.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,480.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,475.53
|
| Rate for Payer: Blue Shield of California EPN |
$974.04
|
| Rate for Payer: Cash Price |
$1,084.95
|
| Rate for Payer: Cash Price |
$1,084.95
|
| Rate for Payer: Cigna of CA HMO |
$1,543.04
|
| Rate for Payer: Cigna of CA PPO |
$1,784.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$2,049.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,446.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$250.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,608.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$1,928.80
|
| Rate for Payer: Networks By Design Commercial |
$1,567.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,049.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,446.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,446.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC SHUNT EVALUATION
|
Facility
|
IP
|
$2,411.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$482.20 |
| Max. Negotiated Rate |
$2,049.35 |
| Rate for Payer: Cash Price |
$1,084.95
|
| Rate for Payer: Adventist Health Commercial |
$482.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$964.40
|
| Rate for Payer: EPIC Health Plan Senior |
$964.40
|
| Rate for Payer: Galaxy Health WC |
$2,049.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,446.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,608.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$918.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,492.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.64
|
| Rate for Payer: Multiplan Commercial |
$1,928.80
|
| Rate for Payer: Networks By Design Commercial |
$1,567.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,049.35
|
|
|
HC SHUNTOGRAM
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.71 |
| Max. Negotiated Rate |
$774.35 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$597.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$221.90
|
| Rate for Payer: Blue Shield of California Commercial |
$557.53
|
| Rate for Payer: Blue Shield of California EPN |
$368.04
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cigna of CA HMO |
$583.04
|
| Rate for Payer: Cigna of CA PPO |
$674.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$607.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$728.80
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC SHUNTOGRAM
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.20 |
| Max. Negotiated Rate |
$774.35 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$364.40
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$607.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$563.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.64
|
| Rate for Payer: Multiplan Commercial |
$728.80
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
|
|
HC SIALOGRAM
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$417.35 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$196.40
|
| Rate for Payer: EPIC Health Plan Senior |
$196.40
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$327.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$303.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.84
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
|
|
HC SIALOGRAM
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.43 |
| Max. Negotiated Rate |
$605.23 |
| Rate for Payer: Adventist Health Commercial |
$98.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$322.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.25
|
| Rate for Payer: Blue Shield of California Commercial |
$300.49
|
| Rate for Payer: Blue Shield of California EPN |
$198.36
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cash Price |
$220.95
|
| Rate for Payer: Cigna of CA HMO |
$314.24
|
| Rate for Payer: Cigna of CA PPO |
$363.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$417.35
|
| Rate for Payer: Global Benefits Group Commercial |
$294.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$327.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$117.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Networks By Design Commercial |
$319.15
|
| Rate for Payer: Prime Health Services Commercial |
$417.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$294.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$294.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
IP
|
$2,962.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$592.40 |
| Max. Negotiated Rate |
$2,517.70 |
| Rate for Payer: Adventist Health Commercial |
$592.40
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.80
|
| Rate for Payer: Galaxy Health WC |
$2,517.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,777.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,975.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,128.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,833.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.88
|
| Rate for Payer: Multiplan Commercial |
$2,369.60
|
| Rate for Payer: Networks By Design Commercial |
$1,925.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,517.70
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
OP
|
$2,962.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.67 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$592.40
|
| 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: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cigna of CA HMO |
$1,895.68
|
| Rate for Payer: Cigna of CA PPO |
$2,191.88
|
| 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 |
$2,517.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,777.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$65.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,975.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.88
|
| 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 |
$2,369.60
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,925.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,517.70
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,777.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: 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 SIALOGRAPHY INJECTION
|
Facility
|
OP
|
$387.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$212.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$290.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: Cigna of CA HMO |
$247.68
|
| Rate for Payer: Cigna of CA PPO |
$286.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$328.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$328.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$367.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$239.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$270.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$270.90
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$232.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$328.95
|
| Rate for Payer: Vantage Medical Group Senior |
$328.95
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
IP
|
$387.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.40 |
| Max. Negotiated Rate |
$328.95 |
| Rate for Payer: Adventist Health Commercial |
$77.40
|
| Rate for Payer: Cash Price |
$174.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.80
|
| Rate for Payer: EPIC Health Plan Senior |
$154.80
|
| Rate for Payer: Galaxy Health WC |
$328.95
|
| Rate for Payer: Global Benefits Group Commercial |
$232.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$258.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$147.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$239.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.88
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Networks By Design Commercial |
$251.55
|
| Rate for Payer: Prime Health Services Commercial |
$328.95
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
|
IP
|
$7,530.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,506.00 |
| Max. Negotiated Rate |
$6,400.50 |
| Rate for Payer: Adventist Health Commercial |
$1,506.00
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,012.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,012.00
|
| Rate for Payer: Galaxy Health WC |
$6,400.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,518.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,022.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,868.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,661.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,807.20
|
| Rate for Payer: Multiplan Commercial |
$6,024.00
|
| Rate for Payer: Networks By Design Commercial |
$4,894.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,400.50
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
|
OP
|
$7,530.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$6,757.85 |
| Rate for Payer: Adventist Health Commercial |
$1,506.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Cash Price |
$3,388.50
|
| Rate for Payer: Cigna of CA HMO |
$4,819.20
|
| Rate for Payer: Cigna of CA PPO |
$5,572.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$6,400.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,518.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,022.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,807.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$6,024.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$4,894.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,400.50
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,518.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,765.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,765.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,765.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
OP
|
$3,712.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906811490
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$437.88 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$742.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,434.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,155.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,041.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,784.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| 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 |
$1,670.40
|
| Rate for Payer: Cash Price |
$1,670.40
|
| Rate for Payer: Cash Price |
$1,670.40
|
| Rate for Payer: Cigna of CA HMO |
$2,375.68
|
| Rate for Payer: Cigna of CA PPO |
$2,746.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,155.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,155.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,484.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,484.80
|
| Rate for Payer: Galaxy Health WC |
$3,155.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,227.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$437.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,475.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,297.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$890.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,598.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,598.40
|
| Rate for Payer: Multiplan Commercial |
$2,969.60
|
| Rate for Payer: Networks By Design Commercial |
$2,412.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,155.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,227.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,227.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,155.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,155.20
|
| Rate for Payer: Vantage Medical Group Senior |
$3,155.20
|
|
