|
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 |
$191.73
|
| 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 |
$153.62
|
| 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: United Healthcare HMO Rider |
$139.65
|
| 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 |
$153.62
|
| 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 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
|
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: Adventist Health Commercial |
$482.20
|
| Rate for Payer: Cash Price |
$1,326.05
|
| 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 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 |
$1,326.05
|
| Rate for Payer: Cash Price |
$1,326.05
|
| 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 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 |
$501.05
|
| Rate for Payer: Cash Price |
$501.05
|
| 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 |
$501.05
|
| 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 |
$270.05
|
| 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 |
$270.05
|
| Rate for Payer: Cash Price |
$270.05
|
| 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
|
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 |
$1,629.10
|
| Rate for Payer: Cash Price |
$1,629.10
|
| Rate for Payer: Cash Price |
$1,629.10
|
| 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 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 |
$1,629.10
|
| 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 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 |
$212.85
|
| 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 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 |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| Rate for Payer: Cash Price |
$212.85
|
| 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 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 |
$4,141.50
|
| 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 |
$4,141.50
|
| Rate for Payer: Cash Price |
$4,141.50
|
| Rate for Payer: Cash Price |
$4,141.50
|
| 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
|
IP
|
$3,712.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906811490
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$742.40 |
| Max. Negotiated Rate |
$3,155.20 |
| Rate for Payer: Adventist Health Commercial |
$742.40
|
| Rate for Payer: Cash Price |
$2,041.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$2,475.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.27
|
| 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: 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
|
|
|
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 |
$2,041.60
|
| Rate for Payer: Cash Price |
$2,041.60
|
| Rate for Payer: Cash Price |
$2,041.60
|
| 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
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
IP
|
$4,367.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906820024
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$873.40 |
| Max. Negotiated Rate |
$3,711.95 |
| Rate for Payer: Adventist Health Commercial |
$873.40
|
| Rate for Payer: Cash Price |
$2,401.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,746.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,746.80
|
| Rate for Payer: Galaxy Health WC |
$3,711.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,620.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,663.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,703.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.08
|
| Rate for Payer: Multiplan Commercial |
$3,493.60
|
| Rate for Payer: Networks By Design Commercial |
$2,838.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,711.95
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
OP
|
$4,367.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906820024
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$437.88 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$873.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,864.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,711.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,401.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,275.25
|
| 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 |
$2,401.85
|
| Rate for Payer: Cash Price |
$2,401.85
|
| Rate for Payer: Cash Price |
$2,401.85
|
| Rate for Payer: Cigna of CA HMO |
$2,794.88
|
| Rate for Payer: Cigna of CA PPO |
$3,231.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,711.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,711.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,711.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,746.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,746.80
|
| Rate for Payer: Galaxy Health WC |
$3,711.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,620.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$437.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,912.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$495.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,703.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,048.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,056.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,056.90
|
| Rate for Payer: Multiplan Commercial |
$3,493.60
|
| Rate for Payer: Networks By Design Commercial |
$2,838.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,711.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,620.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,620.20
|
| 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 |
$3,711.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,711.95
|
| Rate for Payer: Vantage Medical Group Senior |
$3,711.95
|
|
|
HC SICKLE CELL SCREEN
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.66
|
| Rate for Payer: Blue Shield of California Commercial |
$64.22
|
| Rate for Payer: Blue Shield of California EPN |
$42.43
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$5.51
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.46
|
| Rate for Payer: United Healthcare All Other HMO |
$4.46
|
| Rate for Payer: United Healthcare HMO Rider |
$4.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$5.51
|
|
|
HC SICKLE CELL SCREEN
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
900910034
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC SIGMDSCPY DX W WO COLLECT
|
Facility
|
OP
|
$4,431.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
906745330
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$91.95 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$886.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,437.05
|
| Rate for Payer: Cash Price |
$2,437.05
|
| Rate for Payer: Cash Price |
$2,437.05
|
| Rate for Payer: Cigna of CA HMO |
$2,835.84
|
| Rate for Payer: Cigna of CA PPO |
$3,278.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$3,766.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,658.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$91.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,955.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,063.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$3,544.80
|
| Rate for Payer: Networks By Design Commercial |
$2,880.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,766.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,658.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC SIGMDSCPY DX W WO COLLECT
|
Facility
|
IP
|
$4,431.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
906745330
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$886.20 |
| Max. Negotiated Rate |
$3,766.35 |
| Rate for Payer: Adventist Health Commercial |
$886.20
|
| Rate for Payer: Cash Price |
$2,437.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,772.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,772.40
|
| Rate for Payer: Galaxy Health WC |
$3,766.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,658.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,955.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,688.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,742.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,063.44
|
| Rate for Payer: Multiplan Commercial |
$3,544.80
|
| Rate for Payer: Networks By Design Commercial |
$2,880.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,766.35
|
|
|
HC SIGMDSCPY FLEX W POLYPECTOMY
|
Facility
|
OP
|
$4,826.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
906745333
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$178.26 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$965.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,158.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,654.30
|
| Rate for Payer: Cash Price |
$2,654.30
|
| Rate for Payer: Cash Price |
$2,654.30
|
| Rate for Payer: Cigna of CA HMO |
$3,088.64
|
| Rate for Payer: Cigna of CA PPO |
$3,571.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,274.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,158.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,563.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1,158.42
|
| Rate for Payer: Galaxy Health WC |
$4,102.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,895.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$178.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,218.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,158.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,459.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$3,860.80
|
| Rate for Payer: Networks By Design Commercial |
$3,136.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,102.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,895.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,737.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,274.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,158.42
|
|
|
HC SIGMDSCPY FLEX W POLYPECTOMY
|
Facility
|
IP
|
$4,826.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
906745333
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$965.20 |
| Max. Negotiated Rate |
$4,102.10 |
| Rate for Payer: Adventist Health Commercial |
$965.20
|
| Rate for Payer: Cash Price |
$2,654.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,930.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,930.40
|
| Rate for Payer: Galaxy Health WC |
$4,102.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,895.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,218.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,838.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,987.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,158.24
|
| Rate for Payer: Multiplan Commercial |
$3,860.80
|
| Rate for Payer: Networks By Design Commercial |
$3,136.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,102.10
|
|
