|
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 |
$813.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,183.20
|
| 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 Permanente of CA Commercial/Self Funded |
$986.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$915.50
|
| 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$813.45
|
| Rate for Payer: Cash Price |
$813.45
|
| Rate for Payer: Cash Price |
$813.45
|
| Rate for Payer: Cash Price |
$813.45
|
| 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 |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| 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 |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$986.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| 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 |
$304.79
|
| 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 |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| 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 |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
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 |
$387.20
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| 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 Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.78
|
| 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, 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| 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 |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| 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 |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| 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 |
$304.79
|
| 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 |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| 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 |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
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 |
$813.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,183.20
|
| 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 Permanente of CA Commercial/Self Funded |
$986.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$915.50
|
| 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$813.45
|
| Rate for Payer: Cash Price |
$813.45
|
| Rate for Payer: Cash Price |
$813.45
|
| Rate for Payer: Cash Price |
$813.45
|
| 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 |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| 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 |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$986.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$295.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| 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 |
$304.79
|
| 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 |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| 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 |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
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 |
$387.20
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| 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 Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$435.78
|
| 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$485.64
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| Rate for Payer: Cash Price |
$387.20
|
| 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 |
$457.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$304.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.47
|
| Rate for Payer: EPIC Health Plan Senior |
$304.79
|
| 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 |
$499.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$304.79
|
| Rate for Payer: InnovAge PACE Commercial |
$457.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$304.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.42
|
| 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 |
$304.79
|
| 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 |
$323.08
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Riverside University Health System MISP |
$335.27
|
| 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 |
$304.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.27
|
| Rate for Payer: Vantage Medical Group Senior |
$304.79
|
|
|
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 |
$200.75
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| 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 Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| 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 |
$58.63 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$58.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Cash Price |
$200.75
|
| 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 |
$87.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.15
|
| Rate for Payer: EPIC Health Plan Senior |
$58.63
|
| 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 |
$96.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$72.11
|
| Rate for Payer: InnovAge PACE Commercial |
$87.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$78.56
|
| 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 |
$58.63
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Prime Health Services Medicare |
$62.15
|
| Rate for Payer: Riverside University Health System MISP |
$64.49
|
| 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 |
$58.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$87.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.49
|
| Rate for Payer: Vantage Medical Group Senior |
$58.63
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| 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 |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$316.75
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,247.20
|
| Rate for Payer: Cigna of CA HMO |
$997.76
|
| Rate for Payer: Cigna of CA PPO |
$1,153.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,403.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,039.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$1,169.25
|
| Rate for Payer: Multiplan WC |
$316.75
|
| Rate for Payer: Networks By Design Commercial |
$1,013.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| 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 Medicare |
$210.73
|
| Rate for Payer: Prime Health Services WC |
$313.51
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$935.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$779.50
|
| Rate for Payer: United Healthcare All Other HMO |
$779.50
|
| Rate for Payer: United Healthcare HMO Rider |
$779.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$779.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$311.80 |
| Max. Negotiated Rate |
$1,403.10 |
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,247.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.60
|
| Rate for Payer: EPIC Health Plan Senior |
$623.60
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,403.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,039.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$965.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.80
|
| Rate for Payer: Multiplan Commercial |
$1,169.25
|
| Rate for Payer: Networks By Design Commercial |
$1,013.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,325.15
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$198.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$198.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$754.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$915.60
|
| 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 |
$857.45
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,247.20
|
| Rate for Payer: Cigna of CA HMO |
$997.76
|
| Rate for Payer: Cigna of CA PPO |
$1,153.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$298.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$218.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$268.38
|
| Rate for Payer: EPIC Health Plan Senior |
$198.80
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,403.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$198.80
|
| Rate for Payer: InnovAge PACE Commercial |
$298.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,039.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$266.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$266.39
|
| Rate for Payer: Multiplan Commercial |
$1,169.25
|
| Rate for Payer: Networks By Design Commercial |
$1,013.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,325.15
|
| Rate for Payer: Prime Health Services Medicare |
$210.73
|
| Rate for Payer: Riverside University Health System MISP |
$218.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$935.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$198.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$298.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$218.68
|
| Rate for Payer: Vantage Medical Group Senior |
$198.80
|
|
|
HC UNLSTD DIAG GASTROENTEROLOGY
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
906791299
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$311.80 |
| Max. Negotiated Rate |
$1,403.10 |
| Rate for Payer: Adventist Health Commercial |
$311.80
|
| Rate for Payer: Cash Price |
$857.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,247.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.60
|
| Rate for Payer: EPIC Health Plan Senior |
$623.60
|
| Rate for Payer: Galaxy Health WC |
$1,325.15
|
| Rate for Payer: Global Benefits Group Commercial |
$935.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,403.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,039.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$593.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$965.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.80
|
| Rate for Payer: Multiplan Commercial |
$1,169.25
|
| Rate for Payer: Networks By Design Commercial |
$1,013.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,325.15
|
|
|
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 |
$6,248.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$552.20
|
| Rate for Payer: Cash Price |
$552.20
|
| Rate for Payer: Cash Price |
$552.20
|
| Rate for Payer: Cash Price |
$552.20
|
| 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 |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| 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 |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| 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 |
$309.02
|
| 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 |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| 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 |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
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 |
$552.20
|
| Rate for Payer: Central Health Plan Commercial |
$803.20
|
| 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 Permanente of CA Commercial/Self Funded |
$669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$621.48
|
| 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
|
OP
|
$3,367.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$246.67 |
| Max. Negotiated Rate |
$3,030.30 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$246.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$393.03
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Cash Price |
$1,851.85
|
| 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 |
$370.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$271.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$246.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.00
|
| Rate for Payer: EPIC Health Plan Senior |
$246.67
|
| 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 |
$404.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$246.67
|
| Rate for Payer: InnovAge PACE Commercial |
$370.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,245.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$673.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$330.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$330.54
|
| 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 |
$246.67
|
| 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 |
$261.47
|
| Rate for Payer: Prime Health Services WC |
$389.02
|
| Rate for Payer: Riverside University Health System MISP |
$271.34
|
| 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 |
$1,683.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,683.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,683.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$246.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$370.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$271.34
|
| Rate for Payer: Vantage Medical Group Senior |
$246.67
|
|
|
HC UNLSTD PROCEDURE TRACHEA BRONC
|
Facility
|
IP
|
$3,367.00
|
|
|
Service Code
|
CPT 31899
|
| Hospital Charge Code |
900501511
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$673.40 |
| Max. Negotiated Rate |
$3,030.30 |
| Rate for Payer: Adventist Health Commercial |
$673.40
|
| Rate for Payer: Cash Price |
$1,851.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,693.60
|
| 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 Permanente of CA Commercial/Self Funded |
$2,245.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,282.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,084.17
|
| 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 PROC PALATE/UVULA
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$169.33
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$250.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Central Health Plan Commercial |
$330.40
|
| Rate for Payer: Cigna of CA HMO |
$264.32
|
| Rate for Payer: Cigna of CA PPO |
$305.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Central Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.60
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| 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 |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Central Health Plan Commercial |
$330.40
|
| Rate for Payer: Cigna of CA HMO |
$264.32
|
| Rate for Payer: Cigna of CA PPO |
$305.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$206.50
|
| Rate for Payer: United Healthcare All Other HMO |
$206.50
|
| Rate for Payer: United Healthcare HMO Rider |
$206.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC UNLSTD PROC PALATE/UVULA
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 42299
|
| Hospital Charge Code |
900501745
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$371.70 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Central Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$371.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.60
|
| Rate for Payer: Multiplan Commercial |
$309.75
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
|
IP
|
$1,037.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$933.30 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| Rate for Payer: Cash Price |
$570.35
|
| Rate for Payer: Central Health Plan Commercial |
$829.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.80
|
| Rate for Payer: EPIC Health Plan Senior |
$414.80
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$933.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$395.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$641.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.40
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
|
|
HC UNLSTD TEAR DUCT SYSTEM SURGRY
|
Facility
|
OP
|
$1,037.00
|
|
|
Service Code
|
CPT 68899
|
| Hospital Charge Code |
900501716
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$207.40 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$207.40
|
| 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 |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$605.18
|
| Rate for Payer: Cash Price |
$570.35
|
| Rate for Payer: Cash Price |
$570.35
|
| Rate for Payer: Cash Price |
$570.35
|
| Rate for Payer: Cash Price |
$570.35
|
| Rate for Payer: Central Health Plan Commercial |
$829.60
|
| Rate for Payer: Cigna of CA HMO |
$663.68
|
| Rate for Payer: Cigna of CA PPO |
$767.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$881.45
|
| Rate for Payer: Global Benefits Group Commercial |
$622.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$933.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: InnovAge PACE Commercial |
$569.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$691.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$508.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$777.75
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$674.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$379.82
|
| Rate for Payer: Preferred Health Network WC |
$617.53
|
| Rate for Payer: Prime Health Services Commercial |
$881.45
|
| Rate for Payer: Prime Health Services Medicare |
$402.61
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Riverside University Health System MISP |
$417.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$622.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$518.50
|
| Rate for Payer: United Healthcare All Other HMO |
$518.50
|
| Rate for Payer: United Healthcare HMO Rider |
$518.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$518.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC UNLST PROC CASTING/STRAPPING
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 29799
|
| Hospital Charge Code |
900501651
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.40 |
| Max. Negotiated Rate |
$613.80 |
| Rate for Payer: Adventist Health Commercial |
$136.40
|
| Rate for Payer: Cash Price |
$375.10
|
| Rate for Payer: Central Health Plan Commercial |
$545.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.80
|
| Rate for Payer: EPIC Health Plan Senior |
$272.80
|
| Rate for Payer: Galaxy Health WC |
$579.70
|
| Rate for Payer: Global Benefits Group Commercial |
$409.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$613.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$454.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$422.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.40
|
| Rate for Payer: Multiplan Commercial |
$511.50
|
| Rate for Payer: Networks By Design Commercial |
$443.30
|
| Rate for Payer: Prime Health Services Commercial |
$579.70
|
|
