|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.21
|
| 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 |
$432.85
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: Cigna of CA HMO |
$503.68
|
| Rate for Payer: Cigna of CA PPO |
$582.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$668.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$668.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$668.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$418.79
|
| Rate for Payer: InnovAge PACE Commercial |
$393.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$550.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$550.90
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: Riverside University Health System MISP |
$314.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$668.95
|
| Rate for Payer: Vantage Medical Group Senior |
$668.95
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
906820180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$833.40 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Cash Price |
$509.30
|
| Rate for Payer: Central Health Plan Commercial |
$740.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$370.40
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$833.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$573.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.20
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.21
|
| 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 |
$432.85
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: Cigna of CA HMO |
$503.68
|
| Rate for Payer: Cigna of CA PPO |
$582.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$668.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$668.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$668.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$393.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$550.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$550.90
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: Riverside University Health System MISP |
$314.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$668.95
|
| Rate for Payer: Vantage Medical Group Senior |
$668.95
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.40
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$833.40 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Cash Price |
$509.30
|
| Rate for Payer: Central Health Plan Commercial |
$740.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$370.40
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$833.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$573.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.20
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$787.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$509.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$694.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$543.84
|
| 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 |
$509.30
|
| Rate for Payer: Cash Price |
$509.30
|
| Rate for Payer: Cash Price |
$509.30
|
| Rate for Payer: Central Health Plan Commercial |
$740.80
|
| Rate for Payer: Cigna of CA HMO |
$592.64
|
| Rate for Payer: Cigna of CA PPO |
$685.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$787.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$787.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$787.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$370.40
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$833.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$463.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$573.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$648.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$648.20
|
| Rate for Payer: Multiplan Commercial |
$694.50
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
| Rate for Payer: Riverside University Health System MISP |
$370.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.60
|
| 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 |
$787.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$787.10
|
| Rate for Payer: Vantage Medical Group Senior |
$787.10
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.00 |
| Max. Negotiated Rate |
$585.00 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Central Health Plan Commercial |
$520.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$260.00
|
| Rate for Payer: Galaxy Health WC |
$552.50
|
| Rate for Payer: Global Benefits Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$247.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
| Rate for Payer: Networks By Design Commercial |
$422.50
|
| Rate for Payer: Prime Health Services Commercial |
$552.50
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.41 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$130.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$552.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$357.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$487.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$314.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.75
|
| 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 |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Cash Price |
$357.50
|
| Rate for Payer: Central Health Plan Commercial |
$520.00
|
| Rate for Payer: Cigna of CA HMO |
$416.00
|
| Rate for Payer: Cigna of CA PPO |
$481.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$552.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$552.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$552.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.00
|
| Rate for Payer: EPIC Health Plan Senior |
$260.00
|
| Rate for Payer: Galaxy Health WC |
$552.50
|
| Rate for Payer: Global Benefits Group Commercial |
$390.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$585.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.41
|
| Rate for Payer: InnovAge PACE Commercial |
$325.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$433.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$402.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$455.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$455.00
|
| Rate for Payer: Multiplan Commercial |
$487.50
|
| Rate for Payer: Networks By Design Commercial |
$422.50
|
| Rate for Payer: Prime Health Services Commercial |
$552.50
|
| Rate for Payer: Riverside University Health System MISP |
$260.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$390.00
|
| 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 |
$552.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$552.50
|
| Rate for Payer: Vantage Medical Group Senior |
$552.50
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$79.41 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$650.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$420.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$573.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$370.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.28
|
| 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 |
$420.75
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Central Health Plan Commercial |
$612.00
|
| Rate for Payer: Cigna of CA HMO |
$489.60
|
| Rate for Payer: Cigna of CA PPO |
$566.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$650.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$650.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$650.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$688.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$79.41
|
| Rate for Payer: InnovAge PACE Commercial |
$382.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$473.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$573.75
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
| Rate for Payer: Riverside University Health System MISP |
$306.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.00
|
| 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 |
$650.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$650.25
|
| Rate for Payer: Vantage Medical Group Senior |
$650.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$688.50 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$420.75
|
| Rate for Payer: Central Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$688.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$473.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.00
|
| Rate for Payer: Multiplan Commercial |
$573.75
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
915352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.11 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$320.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.27
|
| Rate for Payer: Blue Shield of California Commercial |
$604.49
|
| Rate for Payer: Blue Shield of California EPN |
$394.13
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$664.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$371.83
|
| Rate for Payer: InnovAge PACE Commercial |
$391.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$391.00
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Riverside University Health System MISP |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.48
|
| Rate for Payer: United Healthcare All Other HMO |
$285.66
|
| Rate for Payer: United Healthcare HMO Rider |
$279.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
915352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Blue Shield of California Commercial |
$604.49
|
| Rate for Payer: Blue Shield of California EPN |
$394.13
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.48
|
| Rate for Payer: United Healthcare All Other HMO |
$285.66
|
| Rate for Payer: United Healthcare HMO Rider |
$279.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.11
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
905352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$256.11 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$320.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$586.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$459.27
|
| Rate for Payer: Blue Shield of California Commercial |
$604.49
|
| Rate for Payer: Blue Shield of California EPN |
$394.13
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$664.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$371.83
|
| Rate for Payer: InnovAge PACE Commercial |
$391.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$547.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$391.00
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Riverside University Health System MISP |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.48
|
| Rate for Payer: United Healthcare All Other HMO |
$285.66
|
| Rate for Payer: United Healthcare HMO Rider |
$279.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
905352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Adventist Health Commercial |
$156.40
|
| Rate for Payer: Blue Shield of California Commercial |
$604.49
|
| Rate for Payer: Blue Shield of California EPN |
$394.13
|
| Rate for Payer: Cash Price |
$430.10
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Senior |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$484.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$508.30
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.48
|
| Rate for Payer: United Healthcare All Other HMO |
$285.66
|
| Rate for Payer: United Healthcare HMO Rider |
$279.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.11
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
905352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Blue Shield of California Commercial |
$332.39
|
| Rate for Payer: Blue Shield of California EPN |
$216.72
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
915352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.82 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$176.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.54
|
| Rate for Payer: Blue Shield of California Commercial |
$332.39
|
| Rate for Payer: Blue Shield of California EPN |
$216.72
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$169.90
|
| Rate for Payer: InnovAge PACE Commercial |
$215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$301.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Riverside University Health System MISP |
$172.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
915352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$86.00
|
| Rate for Payer: Blue Shield of California Commercial |
$332.39
|
| Rate for Payer: Blue Shield of California EPN |
$216.72
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$279.50
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
905352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.82 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Adventist Health Commercial |
$176.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$322.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.54
|
| Rate for Payer: Blue Shield of California Commercial |
$332.39
|
| Rate for Payer: Blue Shield of California EPN |
$216.72
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Cash Price |
$236.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$365.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Senior |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$169.90
|
| Rate for Payer: InnovAge PACE Commercial |
$215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$301.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$301.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Riverside University Health System MISP |
$172.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$161.38
|
| Rate for Payer: United Healthcare All Other HMO |
$157.08
|
| Rate for Payer: United Healthcare HMO Rider |
$153.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$140.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
IP
|
$4,370.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$874.00 |
| Max. Negotiated Rate |
$3,933.00 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.00
|
| Rate for Payer: Galaxy Health WC |
$3,714.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,933.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,914.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,664.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,705.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.00
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: Networks By Design Commercial |
$2,840.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,714.50
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
OP
|
$4,370.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.17 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$874.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,403.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,277.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,115.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,566.50
|
| 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 |
$2,403.50
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Cash Price |
$2,403.50
|
| Rate for Payer: Central Health Plan Commercial |
$3,496.00
|
| Rate for Payer: Cigna of CA HMO |
$2,796.80
|
| Rate for Payer: Cigna of CA PPO |
$3,233.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,714.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,714.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,714.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,748.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,748.00
|
| Rate for Payer: Galaxy Health WC |
$3,714.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,622.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,933.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.17
|
| Rate for Payer: InnovAge PACE Commercial |
$2,185.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,914.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,705.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$874.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,059.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,059.00
|
| Rate for Payer: Multiplan Commercial |
$3,277.50
|
| Rate for Payer: Networks By Design Commercial |
$2,840.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,714.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,748.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,622.00
|
| 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 |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,714.50
|
| Rate for Payer: Vantage Medical Group Senior |
$3,714.50
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
IP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,438.40 |
| Max. Negotiated Rate |
$6,472.80 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,876.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,876.80
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,740.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,451.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
OP
|
$7,192.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$343.23 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,438.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,481.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$4,851.77
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Cash Price |
$3,955.60
|
| Rate for Payer: Central Health Plan Commercial |
$5,753.60
|
| Rate for Payer: Cigna of CA HMO |
$4,602.88
|
| Rate for Payer: Cigna of CA PPO |
$5,322.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$6,113.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,315.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,472.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$343.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: InnovAge PACE Commercial |
$3,721.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,797.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,438.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,324.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$5,394.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,674.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$6,113.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,630.06
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,729.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,315.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
IP
|
$29,517.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,903.40 |
| Max. Negotiated Rate |
$26,565.30 |
| Rate for Payer: Adventist Health Commercial |
$5,903.40
|
| Rate for Payer: Cash Price |
$16,234.35
|
| Rate for Payer: Central Health Plan Commercial |
$23,613.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,806.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,806.80
|
| Rate for Payer: Galaxy Health WC |
$25,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$17,710.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,565.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,687.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,245.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,271.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,903.40
|
| Rate for Payer: Multiplan Commercial |
$22,137.75
|
| Rate for Payer: Networks By Design Commercial |
$19,186.05
|
| Rate for Payer: Prime Health Services Commercial |
$25,089.45
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
OP
|
$29,517.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$952.85 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$5,903.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,413.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,413.14
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$11,811.52
|
| 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 |
$16,234.35
|
| Rate for Payer: Cash Price |
$16,234.35
|
| Rate for Payer: Cash Price |
$16,234.35
|
| Rate for Payer: Central Health Plan Commercial |
$23,613.60
|
| Rate for Payer: Cigna of CA HMO |
$18,890.88
|
| Rate for Payer: Cigna of CA PPO |
$21,842.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,154.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,413.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,007.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7,413.14
|
| Rate for Payer: Galaxy Health WC |
$25,089.45
|
| Rate for Payer: Global Benefits Group Commercial |
$17,710.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,565.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,157.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$952.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,413.14
|
| Rate for Payer: InnovAge PACE Commercial |
$11,119.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,687.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,052.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,413.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,903.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,933.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,933.61
|
| Rate for Payer: Multiplan Commercial |
$22,137.75
|
| Rate for Payer: Multiplan WC |
$11,811.52
|
| Rate for Payer: Networks By Design Commercial |
$19,186.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,413.14
|
| Rate for Payer: Preferred Health Network WC |
$12,052.57
|
| Rate for Payer: Prime Health Services Commercial |
$25,089.45
|
| Rate for Payer: Prime Health Services Medicare |
$7,857.93
|
| Rate for Payer: Prime Health Services WC |
$11,690.99
|
| Rate for Payer: Riverside University Health System MISP |
$8,154.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,710.20
|
| 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 |
$7,413.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,119.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,154.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7,413.14
|
|
|
HC ABLATION CRYO SPRAY
|
Facility
|
IP
|
$4,875.00
|
|
| Hospital Charge Code |
900800272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Adventist Health Commercial |
$975.00
|
| Rate for Payer: Cash Price |
$2,681.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,017.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$3,168.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
|
