|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
OP
|
$6,914.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,802.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,185.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,347.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,060.59
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,802.70
|
| Rate for Payer: Cash Price |
$3,802.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,531.20
|
| Rate for Payer: Cigna of CA HMO |
$4,424.96
|
| Rate for Payer: Cigna of CA PPO |
$5,116.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,876.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,876.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,222.60
|
| Rate for Payer: InnovAge PACE Commercial |
$3,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,634.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,279.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,839.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,839.80
|
| Rate for Payer: Multiplan Commercial |
$5,185.50
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,765.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,148.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,457.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,457.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,457.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,457.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,876.90
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
IP
|
$6,914.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$6,222.60 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Cash Price |
$3,802.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,531.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,222.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,634.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,279.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.80
|
| Rate for Payer: Multiplan Commercial |
$5,185.50
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
OP
|
$10,651.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,130.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,130.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,858.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,988.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,157.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,255.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,858.05
|
| Rate for Payer: Cash Price |
$5,858.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,520.80
|
| Rate for Payer: Cigna of CA HMO |
$6,816.64
|
| Rate for Payer: Cigna of CA PPO |
$7,881.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,053.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,053.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,260.40
|
| Rate for Payer: Galaxy Health WC |
$9,053.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,585.90
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,104.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,058.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,592.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,130.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,455.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,455.70
|
| Rate for Payer: Multiplan Commercial |
$7,988.25
|
| Rate for Payer: Networks By Design Commercial |
$6,923.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,053.35
|
| Rate for Payer: Riverside University Health System MISP |
$4,260.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,325.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,325.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,325.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,325.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,053.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9,053.35
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
IP
|
$10,651.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,130.20 |
| Max. Negotiated Rate |
$9,585.90 |
| Rate for Payer: Adventist Health Commercial |
$2,130.20
|
| Rate for Payer: Cash Price |
$5,858.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,260.40
|
| Rate for Payer: Galaxy Health WC |
$9,053.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,585.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,104.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,058.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,592.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,130.20
|
| Rate for Payer: Multiplan Commercial |
$7,988.25
|
| Rate for Payer: Networks By Design Commercial |
$6,923.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,053.35
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
OP
|
$92,272.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$83,044.80 |
| Rate for Payer: Adventist Health Commercial |
$18,454.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78,431.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50,749.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69,204.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44,678.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54,191.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$50,749.60
|
| Rate for Payer: Cash Price |
$50,749.60
|
| Rate for Payer: Central Health Plan Commercial |
$73,817.60
|
| Rate for Payer: Cigna of CA HMO |
$59,054.08
|
| Rate for Payer: Cigna of CA PPO |
$68,281.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78,431.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$78,431.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$78,431.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,908.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36,908.80
|
| Rate for Payer: Galaxy Health WC |
$78,431.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55,363.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$83,044.80
|
| Rate for Payer: InnovAge PACE Commercial |
$46,136.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61,545.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,155.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57,116.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,454.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64,590.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64,590.40
|
| Rate for Payer: Multiplan Commercial |
$69,204.00
|
| Rate for Payer: Networks By Design Commercial |
$59,976.80
|
| Rate for Payer: Prime Health Services Commercial |
$78,431.20
|
| Rate for Payer: Riverside University Health System MISP |
$36,908.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55,363.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$46,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$46,136.00
|
| Rate for Payer: United Healthcare HMO Rider |
$46,136.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46,136.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78,431.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78,431.20
|
| Rate for Payer: Vantage Medical Group Senior |
$78,431.20
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
IP
|
$92,272.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18,454.40 |
| Max. Negotiated Rate |
$83,044.80 |
| Rate for Payer: Adventist Health Commercial |
$18,454.40
|
| Rate for Payer: Cash Price |
$50,749.60
|
| Rate for Payer: Central Health Plan Commercial |
$73,817.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,908.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36,908.80
|
| Rate for Payer: Galaxy Health WC |
$78,431.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55,363.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$83,044.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$61,545.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,155.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$57,116.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,454.40
|
| Rate for Payer: Multiplan Commercial |
$69,204.00
|
| Rate for Payer: Networks By Design Commercial |
$59,976.80
|
| Rate for Payer: Prime Health Services Commercial |
$78,431.20
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
OP
|
$10,651.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,130.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,130.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,858.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,988.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,157.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,255.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,858.05
|
| Rate for Payer: Cash Price |
$5,858.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,520.80
|
| Rate for Payer: Cigna of CA HMO |
$6,816.64
|
| Rate for Payer: Cigna of CA PPO |
$7,881.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,053.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,053.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,260.40
|
| Rate for Payer: Galaxy Health WC |
$9,053.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,585.90
|
| Rate for Payer: InnovAge PACE Commercial |
$5,325.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,104.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,058.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,592.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,130.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,455.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,455.70
|
| Rate for Payer: Multiplan Commercial |
$7,988.25
|
| Rate for Payer: Networks By Design Commercial |
$6,923.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,053.35
|
| Rate for Payer: Riverside University Health System MISP |
$4,260.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,325.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,325.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,325.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,325.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,053.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9,053.35
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
IP
|
$10,651.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,130.20 |
| Max. Negotiated Rate |
$9,585.90 |
| Rate for Payer: Adventist Health Commercial |
$2,130.20
|
| Rate for Payer: Cash Price |
$5,858.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,520.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,260.40
|
| Rate for Payer: Galaxy Health WC |
$9,053.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,585.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,104.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,058.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,592.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,130.20
|
| Rate for Payer: Multiplan Commercial |
$7,988.25
|
| Rate for Payer: Networks By Design Commercial |
$6,923.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,053.35
|
|
|
HC SURGICAL BOOT CHILD EA
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT L3209
|
| Hospital Charge Code |
905353209
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.63
|
| Rate for Payer: Blue Shield of California Commercial |
$58.75
|
| Rate for Payer: Blue Shield of California EPN |
$38.30
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.56
|
| Rate for Payer: InnovAge PACE Commercial |
$38.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$38.00
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Riverside University Health System MISP |
$30.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC SURGICAL BOOT CHILD EA
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT L3209
|
| Hospital Charge Code |
905353209
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Blue Shield of California Commercial |
$58.75
|
| Rate for Payer: Blue Shield of California EPN |
$38.30
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
|
|
HC SURGICAL BOOT INFANT EA
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT L3208
|
| Hospital Charge Code |
905353208
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$37.24 |
| Rate for Payer: Adventist Health Commercial |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.73
|
| Rate for Payer: Blue Shield of California Commercial |
$28.60
|
| Rate for Payer: Blue Shield of California EPN |
$18.65
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Cigna of CA HMO |
$25.90
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.71
|
| Rate for Payer: InnovAge PACE Commercial |
$18.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.90
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$18.50
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Riverside University Health System MISP |
$14.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.89
|
| Rate for Payer: United Healthcare All Other HMO |
$13.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.45
|
| Rate for Payer: Vantage Medical Group Senior |
$31.45
|
|
|
HC SURGICAL BOOT INFANT EA
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT L3208
|
| Hospital Charge Code |
905353208
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.30 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Blue Shield of California Commercial |
$28.60
|
| Rate for Payer: Blue Shield of California EPN |
$18.65
|
| Rate for Payer: Cash Price |
$20.35
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Cigna of CA HMO |
$25.90
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.89
|
| Rate for Payer: United Healthcare All Other HMO |
$13.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.12
|
|
|
HC SURGICAL BOOT JUNIOR, EA
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT L3211
|
| Hospital Charge Code |
905353211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.44
|
| Rate for Payer: Blue Shield of California Commercial |
$70.34
|
| Rate for Payer: Blue Shield of California EPN |
$45.86
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.45
|
| Rate for Payer: InnovAge PACE Commercial |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.70
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Riverside University Health System MISP |
$36.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.15
|
| Rate for Payer: United Healthcare All Other HMO |
$33.24
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.35
|
| Rate for Payer: Vantage Medical Group Senior |
$77.35
|
|
|
HC SURGICAL BOOT JUNIOR, EA
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT L3211
|
| Hospital Charge Code |
905353211
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Blue Shield of California Commercial |
$70.34
|
| Rate for Payer: Blue Shield of California EPN |
$45.86
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.20
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.15
|
| Rate for Payer: United Healthcare All Other HMO |
$33.24
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.80
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
IP
|
$162.47
|
|
| Hospital Charge Code |
901698817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Cash Price |
$89.36
|
| Rate for Payer: Central Health Plan Commercial |
$129.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.49
|
| Rate for Payer: Multiplan Commercial |
$121.85
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
OP
|
$539.63
|
|
| Hospital Charge Code |
901698645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.93 |
| Max. Negotiated Rate |
$485.67 |
| Rate for Payer: Adventist Health Commercial |
$107.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$327.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$458.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$404.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$261.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$316.92
|
| Rate for Payer: Blue Shield of California Commercial |
$329.71
|
| Rate for Payer: Blue Shield of California EPN |
$215.31
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Central Health Plan Commercial |
$431.70
|
| Rate for Payer: Cigna of CA HMO |
$345.36
|
| Rate for Payer: Cigna of CA PPO |
$399.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$458.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$458.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.85
|
| Rate for Payer: EPIC Health Plan Senior |
$215.85
|
| Rate for Payer: Galaxy Health WC |
$458.69
|
| Rate for Payer: Global Benefits Group Commercial |
$323.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$485.67
|
| Rate for Payer: InnovAge PACE Commercial |
$269.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$377.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$377.74
|
| Rate for Payer: Multiplan Commercial |
$404.72
|
| Rate for Payer: Networks By Design Commercial |
$350.76
|
| Rate for Payer: Prime Health Services Commercial |
$458.69
|
| Rate for Payer: Riverside University Health System MISP |
$215.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$323.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$323.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.81
|
| Rate for Payer: United Healthcare All Other HMO |
$269.81
|
| Rate for Payer: United Healthcare HMO Rider |
$269.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$269.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$458.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.69
|
| Rate for Payer: Vantage Medical Group Senior |
$458.69
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
IP
|
$539.63
|
|
| Hospital Charge Code |
901698645
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.93 |
| Max. Negotiated Rate |
$485.67 |
| Rate for Payer: Adventist Health Commercial |
$107.93
|
| Rate for Payer: Cash Price |
$296.80
|
| Rate for Payer: Central Health Plan Commercial |
$431.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.85
|
| Rate for Payer: EPIC Health Plan Senior |
$215.85
|
| Rate for Payer: Galaxy Health WC |
$458.69
|
| Rate for Payer: Global Benefits Group Commercial |
$323.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$485.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$359.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$334.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.93
|
| Rate for Payer: Multiplan Commercial |
$404.72
|
| Rate for Payer: Networks By Design Commercial |
$350.76
|
| Rate for Payer: Prime Health Services Commercial |
$458.69
|
|
|
HC SURGICAL BRA 2X LARGE
|
Facility
|
OP
|
$162.47
|
|
| Hospital Charge Code |
901698817
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.49 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Adventist Health Commercial |
$32.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$95.42
|
| Rate for Payer: Blue Shield of California Commercial |
$99.27
|
| Rate for Payer: Blue Shield of California EPN |
$64.83
|
| Rate for Payer: Cash Price |
$89.36
|
| Rate for Payer: Central Health Plan Commercial |
$129.98
|
| Rate for Payer: Cigna of CA HMO |
$103.98
|
| Rate for Payer: Cigna of CA PPO |
$120.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.99
|
| Rate for Payer: EPIC Health Plan Senior |
$64.99
|
| Rate for Payer: Galaxy Health WC |
$138.10
|
| Rate for Payer: Global Benefits Group Commercial |
$97.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.22
|
| Rate for Payer: InnovAge PACE Commercial |
$81.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.73
|
| Rate for Payer: Multiplan Commercial |
$121.85
|
| Rate for Payer: Networks By Design Commercial |
$105.61
|
| Rate for Payer: Prime Health Services Commercial |
$138.10
|
| Rate for Payer: Riverside University Health System MISP |
$64.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.23
|
| Rate for Payer: United Healthcare All Other HMO |
$81.23
|
| Rate for Payer: United Healthcare HMO Rider |
$81.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.10
|
| Rate for Payer: Vantage Medical Group Senior |
$138.10
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
OP
|
$1,690.00
|
|
|
Service Code
|
CPT 45355
|
| Hospital Charge Code |
906745355
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$338.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$929.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,267.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$818.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$992.54
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: Cigna of CA HMO |
$1,081.60
|
| Rate for Payer: Cigna of CA PPO |
$1,250.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: InnovAge PACE Commercial |
$845.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,183.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,183.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$1,098.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: Riverside University Health System MISP |
$676.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$845.00
|
| Rate for Payer: United Healthcare All Other HMO |
$845.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$845.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,436.50
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
OP
|
$3,568.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$713.60 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$713.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,158.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,962.40
|
| Rate for Payer: Cash Price |
$1,962.40
|
| Rate for Payer: Cash Price |
$1,962.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,854.40
|
| Rate for Payer: Cigna of CA HMO |
$2,283.52
|
| Rate for Payer: Cigna of CA PPO |
$2,640.32
|
| 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 |
$3,032.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,140.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,211.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,899.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,158.42
|
| Rate for Payer: InnovAge PACE Commercial |
$1,737.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,379.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,158.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,552.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,552.28
|
| Rate for Payer: Multiplan Commercial |
$2,676.00
|
| Rate for Payer: Networks By Design Commercial |
$2,319.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,158.42
|
| Rate for Payer: Prime Health Services Commercial |
$3,032.80
|
| Rate for Payer: Prime Health Services Medicare |
$1,227.93
|
| Rate for Payer: Riverside University Health System MISP |
$1,274.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,140.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,390.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,158.42
|
| 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 SURGICAL COLONOSCOPY
|
Facility
|
IP
|
$3,568.00
|
|
|
Service Code
|
CPT 45399
|
| Hospital Charge Code |
906745399
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$713.60 |
| Max. Negotiated Rate |
$3,211.20 |
| Rate for Payer: Adventist Health Commercial |
$713.60
|
| Rate for Payer: Cash Price |
$1,962.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,854.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,427.20
|
| Rate for Payer: Galaxy Health WC |
$3,032.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,140.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,211.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,379.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,359.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,208.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$713.60
|
| Rate for Payer: Multiplan Commercial |
$2,676.00
|
| Rate for Payer: Networks By Design Commercial |
$2,319.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,032.80
|
|
|
HC SURGICAL COLONOSCOPY
|
Facility
|
IP
|
$1,690.00
|
|
|
Service Code
|
CPT 45355
|
| Hospital Charge Code |
906745355
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Adventist Health Commercial |
$338.00
|
| Rate for Payer: Cash Price |
$929.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Senior |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$1,098.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
OP
|
$13,944.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,788.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,788.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,669.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,458.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,751.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,189.31
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$7,669.20
|
| Rate for Payer: Cash Price |
$7,669.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,155.20
|
| Rate for Payer: Cigna of CA HMO |
$8,924.16
|
| Rate for Payer: Cigna of CA PPO |
$10,318.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,852.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,852.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,577.60
|
| Rate for Payer: Galaxy Health WC |
$11,852.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,366.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,549.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,312.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,631.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,788.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,760.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,760.80
|
| Rate for Payer: Multiplan Commercial |
$10,458.00
|
| Rate for Payer: Networks By Design Commercial |
$9,063.60
|
| Rate for Payer: Prime Health Services Commercial |
$11,852.40
|
| Rate for Payer: Riverside University Health System MISP |
$5,577.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,366.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,972.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,972.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,972.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,852.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,852.40
|
| Rate for Payer: Vantage Medical Group Senior |
$11,852.40
|
|
|
HC SURGICAL PROCEDURE
|
Facility
|
IP
|
$13,944.00
|
|
| Hospital Charge Code |
900501689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,788.80 |
| Max. Negotiated Rate |
$12,549.60 |
| Rate for Payer: Adventist Health Commercial |
$2,788.80
|
| Rate for Payer: Cash Price |
$7,669.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,577.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,577.60
|
| Rate for Payer: Galaxy Health WC |
$11,852.40
|
| Rate for Payer: Global Benefits Group Commercial |
$8,366.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,549.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,300.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,312.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,631.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,788.80
|
| Rate for Payer: Multiplan Commercial |
$10,458.00
|
| Rate for Payer: Networks By Design Commercial |
$9,063.60
|
| Rate for Payer: Prime Health Services Commercial |
$11,852.40
|
|
|
HC SURGICAL SPECIMEN
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
909001052
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$1,481.40 |
| Rate for Payer: Adventist Health Commercial |
$329.20
|
| Rate for Payer: Cash Price |
$905.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,316.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$658.40
|
| Rate for Payer: EPIC Health Plan Senior |
$658.40
|
| Rate for Payer: Galaxy Health WC |
$1,399.10
|
| Rate for Payer: Global Benefits Group Commercial |
$987.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,481.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,097.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,018.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.20
|
| Rate for Payer: Multiplan Commercial |
$1,234.50
|
| Rate for Payer: Networks By Design Commercial |
$1,069.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,399.10
|
|
