|
HC UNLISTED PROCEDURE, LARYNX
|
Facility
|
OP
|
$6,623.00
|
|
|
Service Code
|
CPT 31599
|
| Hospital Charge Code |
900501561
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$304.63 |
| Max. Negotiated Rate |
$5,960.70 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Cash Price |
$2,980.35
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: Cigna of CA HMO |
$4,238.72
|
| Rate for Payer: Cigna of CA PPO |
$4,901.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$456.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,636.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.64
|
| Rate for Payer: EPIC Health Plan Senior |
$335.09
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$499.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,205.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$304.63
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
| Rate for Payer: Prime Health Services Medicare |
$322.91
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$335.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,311.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,311.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,311.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,311.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$304.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$456.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.09
|
| Rate for Payer: Vantage Medical Group Senior |
$304.63
|
|
|
HC UNLISTED TX PROC 15MIN MCAL
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900400056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$63.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Riverside University Health System MISP |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC UNLISTED TX PROC 15MIN MCAL
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900400056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC UNLISTED TX PROC 15 MIN PT
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900407139
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.20 |
| Max. Negotiated Rate |
$140.40 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
|
|
HC UNLISTED TX PROC 15 MIN PT
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 97139
|
| Hospital Charge Code |
900407139
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$63.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$85.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Central Health Plan Commercial |
$124.80
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$132.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$132.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$132.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.40
|
| Rate for Payer: EPIC Health Plan Senior |
$62.40
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$140.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$117.00
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Riverside University Health System MISP |
$62.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$132.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$132.60
|
| Rate for Payer: Vantage Medical Group Senior |
$132.60
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
|
OP
|
$2,222.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$444.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,777.60
|
| Rate for Payer: Cigna of CA HMO |
$1,422.08
|
| Rate for Payer: Cigna of CA PPO |
$1,644.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,555.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$1,888.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,333.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,999.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,410.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$1,666.50
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$1,444.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$408.24
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,888.70
|
| Rate for Payer: Prime Health Services Medicare |
$432.73
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$449.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,333.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,111.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,111.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,111.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,111.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC UNLIST PROC CONJUNCTIVA
|
Facility
|
IP
|
$2,222.00
|
|
|
Service Code
|
CPT 68399
|
| Hospital Charge Code |
900501500
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$444.40 |
| Max. Negotiated Rate |
$1,999.80 |
| Rate for Payer: Adventist Health Commercial |
$444.40
|
| Rate for Payer: Cash Price |
$999.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,777.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,555.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$888.80
|
| Rate for Payer: EPIC Health Plan Senior |
$888.80
|
| Rate for Payer: Galaxy Health WC |
$1,888.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,333.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,999.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,410.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,310.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.40
|
| Rate for Payer: Multiplan Commercial |
$1,666.50
|
| Rate for Payer: Networks By Design Commercial |
$1,444.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,888.70
|
|
|
HC UNLIST PROC, FOOT OR TOES
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
900501584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.80 |
| Max. Negotiated Rate |
$1,331.10 |
| Rate for Payer: Adventist Health Commercial |
$295.80
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,183.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,035.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$591.60
|
| Rate for Payer: EPIC Health Plan Senior |
$591.60
|
| Rate for Payer: Galaxy Health WC |
$1,257.15
|
| Rate for Payer: Global Benefits Group Commercial |
$887.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,331.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$939.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$872.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.80
|
| Rate for Payer: Multiplan Commercial |
$1,109.25
|
| Rate for Payer: Networks By Design Commercial |
$961.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,257.15
|
|
|
HC UNLIST PROC, FOOT OR TOES
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
CPT 28899
|
| Hospital Charge Code |
900501584
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.80 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$295.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,183.20
|
| Rate for Payer: Cigna of CA HMO |
$946.56
|
| Rate for Payer: Cigna of CA PPO |
$1,094.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,035.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,257.15
|
| Rate for Payer: Global Benefits Group Commercial |
$887.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,331.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$939.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,109.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$961.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,257.15
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$887.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.50
|
| Rate for Payer: United Healthcare All Other HMO |
$739.50
|
| Rate for Payer: United Healthcare HMO Rider |
$739.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$739.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC UNLIST PROC, HANDS OR FINGERS
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
900501535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$140.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| Rate for Payer: Cigna of CA HMO |
$450.56
|
| Rate for Payer: Cigna of CA PPO |
$520.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$633.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.00
|
| Rate for Payer: United Healthcare All Other HMO |
$352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$352.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC UNLIST PROC, HANDS OR FINGERS
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 26989
|
| Hospital Charge Code |
900501535
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Adventist Health Commercial |
$140.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.60
|
| Rate for Payer: EPIC Health Plan Senior |
$281.60
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$415.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
|
|
HC UNLIST PROC, PELVIS OR HIP JNT
|
Facility
|
IP
|
$1,479.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
900501429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.80 |
| Max. Negotiated Rate |
$1,331.10 |
| Rate for Payer: Adventist Health Commercial |
$295.80
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,183.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,035.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$591.60
|
| Rate for Payer: EPIC Health Plan Senior |
$591.60
|
| Rate for Payer: Galaxy Health WC |
$1,257.15
|
| Rate for Payer: Global Benefits Group Commercial |
$887.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,331.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$939.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$872.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.80
|
| Rate for Payer: Multiplan Commercial |
$1,109.25
|
| Rate for Payer: Networks By Design Commercial |
$961.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,257.15
|
|
|
HC UNLIST PROC, PELVIS OR HIP JNT
|
Facility
|
OP
|
$1,479.00
|
|
|
Service Code
|
CPT 27299
|
| Hospital Charge Code |
900501429
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$295.80 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$295.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Cash Price |
$665.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,183.20
|
| Rate for Payer: Cigna of CA HMO |
$946.56
|
| Rate for Payer: Cigna of CA PPO |
$1,094.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,035.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$1,257.15
|
| Rate for Payer: Global Benefits Group Commercial |
$887.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,331.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$939.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$1,109.25
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$961.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,257.15
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$887.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$739.50
|
| Rate for Payer: United Healthcare All Other HMO |
$739.50
|
| Rate for Payer: United Healthcare HMO Rider |
$739.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$739.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC UNLIST PROC, SHOULDER
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
900501430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Adventist Health Commercial |
$140.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.60
|
| Rate for Payer: EPIC Health Plan Senior |
$281.60
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$415.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
|
|
HC UNLIST PROC, SHOULDER
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 23929
|
| Hospital Charge Code |
900501430
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$140.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| Rate for Payer: Cigna of CA HMO |
$450.56
|
| Rate for Payer: Cigna of CA PPO |
$520.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$492.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$633.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$447.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$317.26
|
| Rate for Payer: Preferred Health Network WC |
$495.55
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
| Rate for Payer: Prime Health Services Medicare |
$336.30
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$348.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.00
|
| Rate for Payer: United Healthcare All Other HMO |
$352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$352.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC UNLSTD CHEMOTHERAPY
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
911800818
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
|
|
HC UNLSTD CHEMOTHERAPY
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT 96549
|
| Hospital Charge Code |
911800818
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$60.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,029.00
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$233.60
|
| Rate for Payer: Cigna of CA PPO |
$270.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$66.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$60.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.38
|
| Rate for Payer: EPIC Health Plan Senior |
$66.25
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$98.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$74.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$80.71
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$60.23
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Prime Health Services Medicare |
$63.84
|
| Rate for Payer: Riverside University Health System MISP |
$66.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Vantage Medical Group Senior |
$60.23
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
OP
|
$2,312.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$462.40
|
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$316.75
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$316.75
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,247.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,849.60
|
| Rate for Payer: Cigna of CA HMO |
$997.76
|
| Rate for Payer: Cigna of CA HMO |
$1,479.68
|
| Rate for Payer: Cigna of CA PPO |
$1,710.88
|
| Rate for Payer: Cigna of CA PPO |
$1,153.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,091.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,618.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$1,965.20
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,387.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,080.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,403.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,468.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$989.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$177.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$1,734.00
|
| Rate for Payer: Multiplan Commercial |
$1,169.25
|
| Rate for Payer: Multiplan WC |
$316.75
|
| Rate for Payer: Multiplan WC |
$316.75
|
| Rate for Payer: Networks By Design Commercial |
$1,013.35
|
| Rate for Payer: Networks By Design Commercial |
$1,502.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Preferred Health Network WC |
$323.21
|
| Rate for Payer: Preferred Health Network WC |
$323.21
|
| Rate for Payer: Prime Health Services Commercial |
$1,325.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,965.20
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Prime Health Services WC |
$313.51
|
| Rate for Payer: Prime Health Services WC |
$313.51
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$935.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$779.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,156.00
|
| Rate for Payer: United Healthcare All Other HMO |
$779.50
|
| Rate for Payer: United Healthcare HMO Rider |
$779.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,156.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,156.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
IP
|
$2,312.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$2,080.80 |
| Rate for Payer: Adventist Health Commercial |
$462.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,849.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,618.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.80
|
| Rate for Payer: EPIC Health Plan Senior |
$924.80
|
| Rate for Payer: Galaxy Health WC |
$1,965.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,387.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,080.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,468.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,364.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.40
|
| Rate for Payer: Multiplan Commercial |
$1,734.00
|
| Rate for Payer: Networks By Design Commercial |
$1,502.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,965.20
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
IP
|
$2,312.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$462.40 |
| Max. Negotiated Rate |
$2,080.80 |
| Rate for Payer: Adventist Health Commercial |
$462.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,849.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,618.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$924.80
|
| Rate for Payer: EPIC Health Plan Senior |
$924.80
|
| Rate for Payer: Galaxy Health WC |
$1,965.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,387.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,080.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,468.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,364.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.40
|
| Rate for Payer: Multiplan Commercial |
$1,734.00
|
| Rate for Payer: Networks By Design Commercial |
$1,502.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,965.20
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
OP
|
$2,312.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$462.40
|
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$754.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,119.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,344.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$906.87
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$701.55
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Cash Price |
$1,040.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,247.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,849.60
|
| Rate for Payer: Cigna of CA HMO |
$997.76
|
| Rate for Payer: Cigna of CA HMO |
$1,479.68
|
| Rate for Payer: Cigna of CA PPO |
$1,153.66
|
| Rate for Payer: Cigna of CA PPO |
$1,710.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,091.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,618.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Galaxy Health WC |
$1,965.20
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,387.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,080.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,403.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,468.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$989.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$1,734.00
|
| Rate for Payer: Multiplan Commercial |
$1,169.25
|
| Rate for Payer: Networks By Design Commercial |
$1,013.35
|
| Rate for Payer: Networks By Design Commercial |
$1,502.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$1,965.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,325.15
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,387.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$935.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$779.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| 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 HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC UNLSTD MALE GENITAL SURG PROC
|
Facility
|
OP
|
$1,004.00
|
|
|
Service Code
|
CPT 55899
|
| Hospital Charge Code |
900501624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Cigna of CA HMO |
$642.56
|
| Rate for Payer: Cigna of CA PPO |
$742.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$652.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$602.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$502.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$502.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$502.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC UNLSTD MALE GENITAL SURG PROC
|
Facility
|
IP
|
$1,004.00
|
|
|
Service Code
|
CPT 55899
|
| Hospital Charge Code |
900501624
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$200.80 |
| Max. Negotiated Rate |
$903.60 |
| Rate for Payer: Adventist Health Commercial |
$200.80
|
| Rate for Payer: Cash Price |
$451.80
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$702.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$401.60
|
| Rate for Payer: EPIC Health Plan Senior |
$401.60
|
| Rate for Payer: Galaxy Health WC |
$853.40
|
| Rate for Payer: Global Benefits Group Commercial |
$602.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$903.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$637.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$592.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.80
|
| Rate for Payer: Multiplan Commercial |
$753.00
|
| Rate for Payer: Networks By Design Commercial |
$652.60
|
| Rate for Payer: Prime Health Services Commercial |
$853.40
|
|
|
HC UNLSTD PROCEDURE TRACHEA BRONC
|
Facility
|
IP
|
$3,367.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$673.40 |
| Max. Negotiated Rate |
$3,030.30 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,693.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,356.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,346.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,346.80
|
| Rate for Payer: Galaxy Health WC |
$2,861.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,030.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,138.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,986.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.40
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
| Rate for Payer: Networks By Design Commercial |
$2,188.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,861.95
|
|
|
HC UNLSTD PROCEDURE TRACHEA BRONC
|
Facility
|
OP
|
$3,367.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.73 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$256.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$256.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,630.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,958.58
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$393.03
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Cash Price |
$1,515.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,693.60
|
| Rate for Payer: Cigna of CA HMO |
$2,154.88
|
| Rate for Payer: Cigna of CA PPO |
$2,491.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$385.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,356.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$423.60
|
| Rate for Payer: EPIC Health Plan Senior |
$282.40
|
| Rate for Payer: Galaxy Health WC |
$2,861.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,020.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,030.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$421.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$256.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,138.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$359.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$344.02
|
| Rate for Payer: Multiplan Commercial |
$2,525.25
|
| Rate for Payer: Multiplan WC |
$393.03
|
| Rate for Payer: Networks By Design Commercial |
$2,188.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$256.73
|
| Rate for Payer: Preferred Health Network WC |
$401.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,861.95
|
| Rate for Payer: Prime Health Services Medicare |
$272.13
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Riverside University Health System MISP |
$282.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,020.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,683.50
|
| 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 |
$256.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$385.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.40
|
| Rate for Payer: Vantage Medical Group Senior |
$256.73
|
|
