|
HC EXT POST MAST GRMNT
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L8015
|
| Hospital Charge Code |
905368015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Blue Shield of California Commercial |
$88.22
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC EXT POST MAST GRMNT
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L8015
|
| Hospital Charge Code |
905368015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.99
|
| Rate for Payer: Blue Shield of California Commercial |
$88.22
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Riverside University Health System MISP |
$44.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC EXT POST MAST GRMNT
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT L8015
|
| Hospital Charge Code |
915368015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.02 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.99
|
| Rate for Payer: Blue Shield of California Commercial |
$88.22
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$64.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$71.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$55.00
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Riverside University Health System MISP |
$44.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC EXT POST MAST GRMNT
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT L8015
|
| Hospital Charge Code |
915368015
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Blue Shield of California Commercial |
$88.22
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$77.00
|
| Rate for Payer: Cigna of CA PPO |
$77.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.28
|
| Rate for Payer: United Healthcare All Other HMO |
$40.18
|
| Rate for Payer: United Healthcare HMO Rider |
$39.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.02
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.66 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$313.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Cigna of CA HMO |
$1,002.24
|
| Rate for Payer: Cigna of CA PPO |
$1,158.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$693.67
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
| Rate for Payer: Prime Health Services Medicare |
$735.29
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$763.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$783.00
|
| Rate for Payer: United Healthcare All Other HMO |
$783.00
|
| Rate for Payer: United Healthcare HMO Rider |
$783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$783.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
OP
|
$1,566.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$254.66 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$642.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,012.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Cigna of CA HMO |
$1,002.24
|
| Rate for Payer: Cigna of CA PPO |
$1,158.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$254.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$745.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$693.67
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
| Rate for Payer: Prime Health Services Medicare |
$735.29
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$763.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$939.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$939.60
|
| 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 |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,409.40 |
| Rate for Payer: Adventist Health Commercial |
$313.20
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Senior |
$626.40
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
IP
|
$1,566.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.20 |
| Max. Negotiated Rate |
$1,409.40 |
| Rate for Payer: Adventist Health Commercial |
$313.20
|
| Rate for Payer: Cash Price |
$704.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,096.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Senior |
$626.40
|
| Rate for Payer: Galaxy Health WC |
$1,331.10
|
| Rate for Payer: Global Benefits Group Commercial |
$939.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,409.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$994.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$923.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.20
|
| Rate for Payer: Multiplan Commercial |
$1,174.50
|
| Rate for Payer: Networks By Design Commercial |
$1,017.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,331.10
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
OP
|
$5,398.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,035.98 |
| Rate for Payer: Adventist Health Commercial |
$1,079.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,318.40
|
| Rate for Payer: Cigna of CA HMO |
$3,454.72
|
| Rate for Payer: Cigna of CA PPO |
$3,994.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,778.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$4,588.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,858.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,427.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$4,048.50
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,508.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,588.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,699.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,699.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,699.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,699.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
IP
|
$5,398.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,079.60 |
| Max. Negotiated Rate |
$4,858.20 |
| Rate for Payer: Adventist Health Commercial |
$1,079.60
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,318.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,778.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,159.20
|
| Rate for Payer: Galaxy Health WC |
$4,588.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,858.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,427.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,184.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.60
|
| Rate for Payer: Multiplan Commercial |
$4,048.50
|
| Rate for Payer: Networks By Design Commercial |
$3,508.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,588.30
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
IP
|
$5,398.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,079.60 |
| Max. Negotiated Rate |
$4,858.20 |
| Rate for Payer: Adventist Health Commercial |
$1,079.60
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,318.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,778.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,159.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,159.20
|
| Rate for Payer: Galaxy Health WC |
$4,588.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,858.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,427.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,184.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.60
|
| Rate for Payer: Multiplan Commercial |
$4,048.50
|
| Rate for Payer: Networks By Design Commercial |
$3,508.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,588.30
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
OP
|
$5,398.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,035.98 |
| Rate for Payer: Adventist Health Commercial |
$2,213.18
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,067.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Cash Price |
$2,429.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,318.40
|
| Rate for Payer: Cigna of CA HMO |
$3,454.72
|
| Rate for Payer: Cigna of CA PPO |
$3,994.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,778.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$4,588.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,238.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,858.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,427.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,079.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$4,048.50
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,508.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,588.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,238.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,238.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
OP
|
$1,346.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
900803201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$167.46 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$269.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$963.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$589.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$782.97
|
| Rate for Payer: Blue Shield of California Commercial |
$847.98
|
| Rate for Payer: Blue Shield of California EPN |
$534.36
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Cigna of CA HMO |
$861.44
|
| Rate for Payer: Cigna of CA PPO |
$996.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$167.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$874.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
IP
|
$1,346.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
900803201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$269.20 |
| Max. Negotiated Rate |
$1,211.40 |
| Rate for Payer: Adventist Health Commercial |
$269.20
|
| Rate for Payer: Cash Price |
$605.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,076.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$942.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.40
|
| Rate for Payer: EPIC Health Plan Senior |
$538.40
|
| Rate for Payer: Galaxy Health WC |
$1,144.10
|
| Rate for Payer: Global Benefits Group Commercial |
$807.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,211.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$854.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$794.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.20
|
| Rate for Payer: Multiplan Commercial |
$1,009.50
|
| Rate for Payer: Networks By Design Commercial |
$874.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.10
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
IP
|
$2,041.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$408.20 |
| Max. Negotiated Rate |
$1,836.90 |
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,632.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,428.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$816.40
|
| Rate for Payer: EPIC Health Plan Senior |
$816.40
|
| Rate for Payer: Galaxy Health WC |
$1,734.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,836.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,296.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,204.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.20
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
OP
|
$2,041.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$167.46 |
| Max. Negotiated Rate |
$1,836.90 |
| Rate for Payer: Adventist Health Commercial |
$408.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$963.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$589.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,187.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,285.83
|
| Rate for Payer: Blue Shield of California EPN |
$810.28
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Cash Price |
$918.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,632.80
|
| Rate for Payer: Cigna of CA HMO |
$1,306.24
|
| Rate for Payer: Cigna of CA PPO |
$1,510.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,428.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$1,734.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,224.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,836.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$167.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,296.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$184.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$408.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$1,530.75
|
| Rate for Payer: Networks By Design Commercial |
$1,326.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$1,734.85
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,224.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,224.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC EXTREMITY STUDY SIMPLE
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$89.61 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$243.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$638.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$312.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$707.35
|
| Rate for Payer: Blue Shield of California Commercial |
$766.08
|
| Rate for Payer: Blue Shield of California EPN |
$482.75
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Central Health Plan Commercial |
$972.80
|
| Rate for Payer: Cigna of CA HMO |
$778.24
|
| Rate for Payer: Cigna of CA PPO |
$899.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,033.60
|
| Rate for Payer: Global Benefits Group Commercial |
$729.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$790.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.60
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$729.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC EXTREMITY STUDY SIMPLE
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT 93922
|
| Hospital Charge Code |
900803200
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$243.20 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Adventist Health Commercial |
$243.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Central Health Plan Commercial |
$972.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.40
|
| Rate for Payer: EPIC Health Plan Senior |
$486.40
|
| Rate for Payer: Galaxy Health WC |
$1,033.60
|
| Rate for Payer: Global Benefits Group Commercial |
$729.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$717.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.20
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$790.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.60
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$2,413.67
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$386.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,709.60
|
| Rate for Payer: Cigna of CA HMO |
$3,767.68
|
| Rate for Payer: Cigna of CA PPO |
$4,356.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,120.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$5,003.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,298.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,738.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,177.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$3,826.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,003.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,532.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,532.20
|
| 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 |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,177.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,723.01
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,709.60
|
| Rate for Payer: Cigna of CA HMO |
$3,767.68
|
| Rate for Payer: Cigna of CA PPO |
$4,356.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,120.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$5,003.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,298.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,738.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,287.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,177.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
| Rate for Payer: Multiplan WC |
$4,723.01
|
| Rate for Payer: Networks By Design Commercial |
$3,826.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Preferred Health Network WC |
$4,819.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,003.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Prime Health Services WC |
$4,674.82
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,532.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,943.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,943.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,943.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,943.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,177.40 |
| Max. Negotiated Rate |
$5,298.30 |
| Rate for Payer: Adventist Health Commercial |
$1,177.40
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,709.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,120.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,354.80
|
| Rate for Payer: Galaxy Health WC |
$5,003.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,298.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,738.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,473.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,177.40
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
| Rate for Payer: Networks By Design Commercial |
$3,826.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,003.95
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
OP
|
$5,887.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$74.13 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,177.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,057.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$386.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,057.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,708.81
|
| Rate for Payer: Blue Shield of California EPN |
$2,337.14
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,709.60
|
| Rate for Payer: Cigna of CA HMO |
$3,767.68
|
| Rate for Payer: Cigna of CA PPO |
$4,356.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,363.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,057.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,120.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,045.44
|
| Rate for Payer: EPIC Health Plan Senior |
$3,363.62
|
| Rate for Payer: Galaxy Health WC |
$5,003.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,298.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,014.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,738.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,280.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,177.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,097.51
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
| Rate for Payer: Networks By Design Commercial |
$3,826.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,057.84
|
| Rate for Payer: Prime Health Services Commercial |
$5,003.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,241.31
|
| Rate for Payer: Riverside University Health System MISP |
$3,363.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,532.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,532.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,057.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,586.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,363.62
|
| Rate for Payer: Vantage Medical Group Senior |
$3,057.84
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,177.40 |
| Max. Negotiated Rate |
$5,298.30 |
| Rate for Payer: Adventist Health Commercial |
$1,177.40
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,709.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,120.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,354.80
|
| Rate for Payer: Galaxy Health WC |
$5,003.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,298.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,738.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,473.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,177.40
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
| Rate for Payer: Networks By Design Commercial |
$3,826.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,003.95
|
|
|
HC EYE EXAM & TREAT W/CON SED LTD
|
Facility
|
IP
|
$5,887.00
|
|
|
Service Code
|
CPT 92019
|
| Hospital Charge Code |
900501662
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$1,177.40 |
| Max. Negotiated Rate |
$5,298.30 |
| Rate for Payer: Adventist Health Commercial |
$1,177.40
|
| Rate for Payer: Cash Price |
$2,649.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,709.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,120.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,354.80
|
| Rate for Payer: Galaxy Health WC |
$5,003.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,298.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,738.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,473.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,177.40
|
| Rate for Payer: Multiplan Commercial |
$4,415.25
|
| Rate for Payer: Networks By Design Commercial |
$3,826.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,003.95
|
|
|
HC EYE FOR FOREIGN BODY
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 70030
|
| Hospital Charge Code |
909001113
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$87.40 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Adventist Health Commercial |
$87.40
|
| Rate for Payer: Cash Price |
$196.65
|
| Rate for Payer: Central Health Plan Commercial |
$349.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$305.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.80
|
| Rate for Payer: EPIC Health Plan Senior |
$174.80
|
| Rate for Payer: Galaxy Health WC |
$371.45
|
| Rate for Payer: Global Benefits Group Commercial |
$262.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$393.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$277.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$257.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.40
|
| Rate for Payer: Multiplan Commercial |
$327.75
|
| Rate for Payer: Networks By Design Commercial |
$284.05
|
| Rate for Payer: Prime Health Services Commercial |
$371.45
|
|
