|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$3,642.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$728.40 |
| Max. Negotiated Rate |
$3,277.80 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Cash Price |
$2,003.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,456.80
|
| Rate for Payer: Galaxy Health WC |
$3,095.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,277.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,254.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.40
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: Networks By Design Commercial |
$2,367.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,095.70
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
IP
|
$3,642.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$728.40 |
| Max. Negotiated Rate |
$3,277.80 |
| Rate for Payer: Adventist Health Commercial |
$728.40
|
| Rate for Payer: Cash Price |
$2,003.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,456.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,456.80
|
| Rate for Payer: Galaxy Health WC |
$3,095.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,277.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,387.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,254.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.40
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: Networks By Design Commercial |
$2,367.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,095.70
|
|
|
HC VENT PUNC THR PREV BURR HOLE
|
Facility
|
OP
|
$3,642.00
|
|
|
Service Code
|
CPT 61020
|
| Hospital Charge Code |
900501253
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,493.22
|
| 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 |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| 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 |
$1,802.37
|
| Rate for Payer: Cash Price |
$2,003.10
|
| Rate for Payer: Cash Price |
$2,003.10
|
| Rate for Payer: Cash Price |
$2,003.10
|
| Rate for Payer: Cash Price |
$2,003.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,913.60
|
| Rate for Payer: Cigna of CA HMO |
$2,330.88
|
| Rate for Payer: Cigna of CA PPO |
$2,695.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$3,095.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,185.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,277.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,696.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,429.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$728.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,515.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,731.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,367.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,095.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,199.07
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,244.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,185.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,185.20
|
| 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 |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC VENT TUBE
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
|
|
HC VENT TUBE
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
909081809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$270.00 |
| Rate for Payer: Adventist Health Commercial |
$60.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$182.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$165.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.19
|
| Rate for Payer: Blue Shield of California Commercial |
$183.30
|
| Rate for Payer: Blue Shield of California EPN |
$119.70
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Central Health Plan Commercial |
$240.00
|
| Rate for Payer: Cigna of CA HMO |
$192.00
|
| Rate for Payer: Cigna of CA PPO |
$222.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$255.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$255.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.00
|
| Rate for Payer: EPIC Health Plan Senior |
$120.00
|
| Rate for Payer: Galaxy Health WC |
$255.00
|
| Rate for Payer: Global Benefits Group Commercial |
$180.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$270.00
|
| Rate for Payer: InnovAge PACE Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$200.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$185.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$210.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$210.00
|
| Rate for Payer: Multiplan Commercial |
$225.00
|
| Rate for Payer: Networks By Design Commercial |
$195.00
|
| Rate for Payer: Prime Health Services Commercial |
$255.00
|
| Rate for Payer: Riverside University Health System MISP |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$180.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$180.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$255.00
|
| Rate for Payer: Vantage Medical Group Senior |
$255.00
|
|
|
HC VEP, CHECKERBOARD/FLASH
|
Facility
|
IP
|
$2,116.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$423.20 |
| Max. Negotiated Rate |
$1,904.40 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,692.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$846.40
|
| Rate for Payer: EPIC Health Plan Senior |
$846.40
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,904.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,411.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$806.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,309.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.20
|
| Rate for Payer: Multiplan Commercial |
$1,587.00
|
| Rate for Payer: Networks By Design Commercial |
$1,375.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
|
|
HC VEP, CHECKERBOARD/FLASH
|
Facility
|
OP
|
$2,116.00
|
|
|
Service Code
|
CPT 95930
|
| Hospital Charge Code |
900600218
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$59.24 |
| Max. Negotiated Rate |
$1,904.40 |
| Rate for Payer: Adventist Health Commercial |
$423.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,285.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,242.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,284.41
|
| Rate for Payer: Blue Shield of California EPN |
$840.05
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Cash Price |
$1,163.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,692.80
|
| Rate for Payer: Cigna of CA HMO |
$1,354.24
|
| Rate for Payer: Cigna of CA PPO |
$1,565.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$1,798.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,269.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,904.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,411.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$423.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$1,587.00
|
| Rate for Payer: Networks By Design Commercial |
$1,375.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$1,798.60
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,269.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,269.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC VERTEBRAL UNI
|
Facility
|
OP
|
$20,694.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
906820224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.11 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$4,138.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$11,381.70
|
| Rate for Payer: Cash Price |
$11,381.70
|
| Rate for Payer: Cash Price |
$11,381.70
|
| Rate for Payer: Central Health Plan Commercial |
$16,555.20
|
| Rate for Payer: Cigna of CA HMO |
$13,244.16
|
| Rate for Payer: Cigna of CA PPO |
$15,313.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$17,589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$12,416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,624.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$484.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,802.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,138.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$15,520.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$13,451.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$17,589.90
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,416.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VERTEBRAL UNI
|
Facility
|
IP
|
$20,694.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
906820224
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,138.80 |
| Max. Negotiated Rate |
$18,624.60 |
| Rate for Payer: Adventist Health Commercial |
$4,138.80
|
| Rate for Payer: Cash Price |
$11,381.70
|
| Rate for Payer: Central Health Plan Commercial |
$16,555.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,277.60
|
| Rate for Payer: Galaxy Health WC |
$17,589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$12,416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,624.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,802.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,884.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,809.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,138.80
|
| Rate for Payer: Multiplan Commercial |
$15,520.50
|
| Rate for Payer: Networks By Design Commercial |
$13,451.10
|
| Rate for Payer: Prime Health Services Commercial |
$17,589.90
|
|
|
HC VERTEBRAL UNI
|
Facility
|
OP
|
$17,590.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$484.11 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,518.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$9,674.50
|
| Rate for Payer: Cash Price |
$9,674.50
|
| Rate for Payer: Cash Price |
$9,674.50
|
| Rate for Payer: Central Health Plan Commercial |
$14,072.00
|
| Rate for Payer: Cigna of CA HMO |
$11,257.60
|
| Rate for Payer: Cigna of CA PPO |
$13,016.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$14,951.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10,554.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,831.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$484.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,732.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,518.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$13,192.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$11,433.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$14,951.50
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,554.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC VERTEBRAL UNI
|
Facility
|
IP
|
$17,590.00
|
|
|
Service Code
|
CPT 36226
|
| Hospital Charge Code |
909020149
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,518.00 |
| Max. Negotiated Rate |
$15,831.00 |
| Rate for Payer: Adventist Health Commercial |
$3,518.00
|
| Rate for Payer: Cash Price |
$9,674.50
|
| Rate for Payer: Central Health Plan Commercial |
$14,072.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,036.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,036.00
|
| Rate for Payer: Galaxy Health WC |
$14,951.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10,554.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,831.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,732.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,701.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,888.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,518.00
|
| Rate for Payer: Multiplan Commercial |
$13,192.50
|
| Rate for Payer: Networks By Design Commercial |
$11,433.50
|
| Rate for Payer: Prime Health Services Commercial |
$14,951.50
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
|
OP
|
$13,725.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$312.49 |
| Max. Negotiated Rate |
$12,352.50 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,666.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,548.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,293.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$7,548.75
|
| Rate for Payer: Cash Price |
$7,548.75
|
| Rate for Payer: Cash Price |
$7,548.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,980.00
|
| Rate for Payer: Cigna of CA HMO |
$8,784.00
|
| Rate for Payer: Cigna of CA PPO |
$10,156.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,666.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,666.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,666.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,490.00
|
| Rate for Payer: Galaxy Health WC |
$11,666.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,235.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,352.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.49
|
| Rate for Payer: InnovAge PACE Commercial |
$6,862.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,154.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,495.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,745.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,607.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,607.50
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
| Rate for Payer: Networks By Design Commercial |
$8,921.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,666.25
|
| Rate for Payer: Riverside University Health System MISP |
$5,490.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,235.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,666.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,666.25
|
| Rate for Payer: Vantage Medical Group Senior |
$11,666.25
|
|
|
HC VERTEBROPLASTY ADDL INJECT
|
Facility
|
IP
|
$13,725.00
|
|
|
Service Code
|
CPT 22512
|
| Hospital Charge Code |
909022512
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,745.00 |
| Max. Negotiated Rate |
$12,352.50 |
| Rate for Payer: Adventist Health Commercial |
$2,745.00
|
| Rate for Payer: Cash Price |
$7,548.75
|
| Rate for Payer: Central Health Plan Commercial |
$10,980.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,490.00
|
| Rate for Payer: Galaxy Health WC |
$11,666.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,235.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,352.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,154.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,229.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,495.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,745.00
|
| Rate for Payer: Multiplan Commercial |
$10,293.75
|
| Rate for Payer: Networks By Design Commercial |
$8,921.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,666.25
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$350.20 |
| Max. Negotiated Rate |
$1,575.90 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,400.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.40
|
| Rate for Payer: EPIC Health Plan Senior |
$700.40
|
| Rate for Payer: Galaxy Health WC |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,575.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$667.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,083.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.20
|
| Rate for Payer: Multiplan Commercial |
$1,313.25
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,488.35
|
|
|
HC VESTIBULE OF MOUTH
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
CPT 40808
|
| Hospital Charge Code |
900501785
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.83 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$350.20
|
| 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 |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,030.97
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Cash Price |
$963.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,400.80
|
| Rate for Payer: Cigna of CA HMO |
$1,120.64
|
| Rate for Payer: Cigna of CA PPO |
$1,295.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$1,488.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,050.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,575.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,167.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$350.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$1,313.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,138.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,488.35
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,050.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$875.50
|
| Rate for Payer: United Healthcare All Other HMO |
$875.50
|
| Rate for Payer: United Healthcare HMO Rider |
$875.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$875.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC VISCOELASTIC TEST
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912037
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$86.40 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC VISCOELASTIC TEST
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 85396
|
| Hospital Charge Code |
900912037
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$15.98 |
| Max. Negotiated Rate |
$116.66 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.68
|
| Rate for Payer: Blue Shield of California Commercial |
$58.27
|
| Rate for Payer: Blue Shield of California EPN |
$38.11
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Central Health Plan Commercial |
$76.80
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$81.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$81.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$81.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$86.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$30.50
|
| Rate for Payer: InnovAge PACE Commercial |
$48.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Riverside University Health System MISP |
$38.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.98
|
| Rate for Payer: United Healthcare All Other HMO |
$15.98
|
| Rate for Payer: United Healthcare HMO Rider |
$15.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$81.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$81.60
|
| Rate for Payer: Vantage Medical Group Senior |
$81.60
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$600.30 |
| Rate for Payer: Adventist Health Commercial |
$133.40
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$266.80
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$412.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| Rate for Payer: Multiplan Commercial |
$500.25
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
|
IP
|
$667.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$600.30 |
| Rate for Payer: Adventist Health Commercial |
$133.40
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.80
|
| Rate for Payer: EPIC Health Plan Senior |
$266.80
|
| Rate for Payer: Galaxy Health WC |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$412.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| Rate for Payer: Multiplan Commercial |
$500.25
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
|
|
HC VITAL CAPACITY TOTAL
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$10.58 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$273.47
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.07
|
| 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 |
$391.73
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$316.75
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: Cigna of CA HMO |
$426.88
|
| Rate for Payer: Cigna of CA PPO |
$493.58
|
| 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 |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| 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 |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| 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 |
$500.25
|
| Rate for Payer: Multiplan WC |
$316.75
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| 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 |
$566.95
|
| 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 |
$400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.20
|
| 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 |
$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 VITAL CAPACITY TOTAL
|
Facility
|
OP
|
$667.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
900800430
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$9.58 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$133.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$198.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.07
|
| 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 |
$22.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.73
|
| Rate for Payer: Blue Shield of California Commercial |
$404.87
|
| Rate for Payer: Blue Shield of California EPN |
$264.80
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Cash Price |
$366.85
|
| Rate for Payer: Central Health Plan Commercial |
$533.60
|
| Rate for Payer: Cigna of CA HMO |
$426.88
|
| Rate for Payer: Cigna of CA PPO |
$493.58
|
| 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 |
$566.95
|
| Rate for Payer: Global Benefits Group Commercial |
$400.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$600.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$326.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.58
|
| 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 |
$444.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.40
|
| 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 |
$500.25
|
| Rate for Payer: Networks By Design Commercial |
$433.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$198.80
|
| Rate for Payer: Prime Health Services Commercial |
$566.95
|
| 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 |
$400.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| 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 VITAMIN B12
|
Facility
|
OP
|
$140.35
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900910830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$126.31 |
| Rate for Payer: Adventist Health Commercial |
$28.07
|
| Rate for Payer: Adventist Health Medi-Cal |
$15.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$85.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.26
|
| Rate for Payer: Blue Shield of California Commercial |
$85.19
|
| Rate for Payer: Blue Shield of California EPN |
$55.72
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Central Health Plan Commercial |
$112.28
|
| Rate for Payer: Cigna of CA HMO |
$89.82
|
| Rate for Payer: Cigna of CA PPO |
$103.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.36
|
| Rate for Payer: EPIC Health Plan Senior |
$15.08
|
| Rate for Payer: Galaxy Health WC |
$119.30
|
| Rate for Payer: Global Benefits Group Commercial |
$84.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.31
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.08
|
| Rate for Payer: InnovAge PACE Commercial |
$22.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$20.21
|
| Rate for Payer: Multiplan Commercial |
$105.26
|
| Rate for Payer: Networks By Design Commercial |
$91.23
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$15.08
|
| Rate for Payer: Prime Health Services Commercial |
$119.30
|
| Rate for Payer: Prime Health Services Medicare |
$15.98
|
| Rate for Payer: Riverside University Health System MISP |
$16.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.21
|
| Rate for Payer: United Healthcare All Other HMO |
$12.21
|
| Rate for Payer: United Healthcare HMO Rider |
$12.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$15.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.59
|
| Rate for Payer: Vantage Medical Group Senior |
$15.08
|
|
|
HC VITAMIN B12
|
Facility
|
IP
|
$140.35
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
900910830
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$126.31 |
| Rate for Payer: Adventist Health Commercial |
$28.07
|
| Rate for Payer: Cash Price |
$77.19
|
| Rate for Payer: Central Health Plan Commercial |
$112.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.14
|
| Rate for Payer: EPIC Health Plan Senior |
$56.14
|
| Rate for Payer: Galaxy Health WC |
$119.30
|
| Rate for Payer: Global Benefits Group Commercial |
$84.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$126.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$93.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$53.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$86.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.07
|
| Rate for Payer: Multiplan Commercial |
$105.26
|
| Rate for Payer: Networks By Design Commercial |
$91.23
|
| Rate for Payer: Prime Health Services Commercial |
$119.30
|
|
|
HC VITAMIN D TOTAL
|
Facility
|
OP
|
$272.05
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$23.98 |
| Max. Negotiated Rate |
$244.84 |
| Rate for Payer: Adventist Health Commercial |
$54.41
|
| Rate for Payer: Adventist Health Medi-Cal |
$29.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.71
|
| Rate for Payer: Blue Shield of California Commercial |
$165.13
|
| Rate for Payer: Blue Shield of California EPN |
$108.00
|
| Rate for Payer: Cash Price |
$149.63
|
| Rate for Payer: Cash Price |
$149.63
|
| Rate for Payer: Central Health Plan Commercial |
$217.64
|
| Rate for Payer: Cigna of CA HMO |
$174.11
|
| Rate for Payer: Cigna of CA PPO |
$201.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.96
|
| Rate for Payer: EPIC Health Plan Senior |
$29.60
|
| Rate for Payer: Galaxy Health WC |
$231.24
|
| Rate for Payer: Global Benefits Group Commercial |
$163.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.84
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$48.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$29.60
|
| Rate for Payer: InnovAge PACE Commercial |
$44.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$204.04
|
| Rate for Payer: Networks By Design Commercial |
$176.83
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$29.60
|
| Rate for Payer: Prime Health Services Commercial |
$231.24
|
| Rate for Payer: Prime Health Services Medicare |
$31.38
|
| Rate for Payer: Riverside University Health System MISP |
$32.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$29.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.56
|
| Rate for Payer: Vantage Medical Group Senior |
$29.60
|
|
|
HC VITAMIN D TOTAL
|
Facility
|
IP
|
$272.05
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
900912240
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$54.41 |
| Max. Negotiated Rate |
$244.84 |
| Rate for Payer: Adventist Health Commercial |
$54.41
|
| Rate for Payer: Cash Price |
$149.63
|
| Rate for Payer: Central Health Plan Commercial |
$217.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.82
|
| Rate for Payer: EPIC Health Plan Senior |
$108.82
|
| Rate for Payer: Galaxy Health WC |
$231.24
|
| Rate for Payer: Global Benefits Group Commercial |
$163.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$244.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$181.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.41
|
| Rate for Payer: Multiplan Commercial |
$204.04
|
| Rate for Payer: Networks By Design Commercial |
$176.83
|
| Rate for Payer: Prime Health Services Commercial |
$231.24
|
|
