|
HC EXPLORE/TREAT FINGER JOINT EA
|
Facility
|
OP
|
$8,829.00
|
|
|
Service Code
|
CPT 26075
|
| Hospital Charge Code |
900501434
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$1,765.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Cash Price |
$3,973.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,063.20
|
| Rate for Payer: Cigna of CA HMO |
$5,650.56
|
| Rate for Payer: Cigna of CA PPO |
$6,533.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$7,504.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,297.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,946.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,888.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,765.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$6,621.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,738.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$7,504.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,297.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,414.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,414.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,414.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,414.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
IP
|
$10,830.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,166.00 |
| Max. Negotiated Rate |
$9,747.00 |
| Rate for Payer: Adventist Health Commercial |
$2,166.00
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,664.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,332.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,332.00
|
| Rate for Payer: Galaxy Health WC |
$9,205.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,747.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,223.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,126.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,703.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,166.00
|
| Rate for Payer: Multiplan Commercial |
$8,122.50
|
| Rate for Payer: Networks By Design Commercial |
$7,039.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,205.50
|
|
|
HC EXPLOR W/RMVL DEEP F.B.FOREARM
|
Facility
|
OP
|
$10,830.00
|
|
|
Service Code
|
CPT 25248
|
| Hospital Charge Code |
900501469
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,747.00 |
| Rate for Payer: Adventist Health Commercial |
$2,166.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,033.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,240.00
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Cash Price |
$4,873.50
|
| Rate for Payer: Central Health Plan Commercial |
$8,664.00
|
| Rate for Payer: Cigna of CA HMO |
$6,931.20
|
| Rate for Payer: Cigna of CA PPO |
$8,014.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,236.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,033.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,033.48
|
| Rate for Payer: Galaxy Health WC |
$9,205.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6,498.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,747.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,334.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,033.48
|
| Rate for Payer: InnovAge PACE Commercial |
$3,050.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,223.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$884.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,033.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,166.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,724.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,724.86
|
| Rate for Payer: Multiplan Commercial |
$8,122.50
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$7,039.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,033.48
|
| Rate for Payer: Preferred Health Network WC |
$3,306.12
|
| Rate for Payer: Prime Health Services Commercial |
$9,205.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,155.49
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,236.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,498.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,415.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,415.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,415.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,415.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,033.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,050.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,236.83
|
| Rate for Payer: Vantage Medical Group Senior |
$2,033.48
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,137.20 |
| Max. Negotiated Rate |
$18,617.40 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Central Health Plan Commercial |
$16,548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,274.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,274.40
|
| Rate for Payer: Galaxy Health WC |
$17,583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$12,411.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,617.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,797.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,881.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,804.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
| Rate for Payer: Networks By Design Commercial |
$13,445.90
|
| Rate for Payer: Prime Health Services Commercial |
$17,583.10
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$20,686.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
909020160
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.41 |
| Max. Negotiated Rate |
$18,617.40 |
| Rate for Payer: Adventist Health Commercial |
$4,137.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,377.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,514.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Cash Price |
$9,308.70
|
| Rate for Payer: Central Health Plan Commercial |
$16,548.80
|
| Rate for Payer: Cigna of CA HMO |
$13,239.04
|
| Rate for Payer: Cigna of CA PPO |
$15,307.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,583.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,583.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,583.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,274.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,274.40
|
| Rate for Payer: Galaxy Health WC |
$17,583.10
|
| Rate for Payer: Global Benefits Group Commercial |
$12,411.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,617.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.41
|
| Rate for Payer: InnovAge PACE Commercial |
$10,343.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,797.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,804.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,137.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,480.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,480.20
|
| Rate for Payer: Multiplan Commercial |
$15,514.50
|
| Rate for Payer: Networks By Design Commercial |
$13,445.90
|
| Rate for Payer: Prime Health Services Commercial |
$17,583.10
|
| Rate for Payer: Riverside University Health System MISP |
$8,274.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,411.60
|
| 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 |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,583.10
|
| Rate for Payer: Vantage Medical Group Senior |
$17,583.10
|
|
|
HC EXT CAROTID UNI
|
Facility
|
OP
|
$24,336.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$152.41 |
| Max. Negotiated Rate |
$21,902.40 |
| Rate for Payer: Adventist Health Commercial |
$4,867.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,685.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,384.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,252.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$10,951.20
|
| Rate for Payer: Cash Price |
$10,951.20
|
| Rate for Payer: Cash Price |
$10,951.20
|
| Rate for Payer: Central Health Plan Commercial |
$19,468.80
|
| Rate for Payer: Cigna of CA HMO |
$15,575.04
|
| Rate for Payer: Cigna of CA PPO |
$18,008.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,685.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,685.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,734.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,734.40
|
| Rate for Payer: Galaxy Health WC |
$20,685.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14,601.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,902.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.41
|
| Rate for Payer: InnovAge PACE Commercial |
$12,168.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,232.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,063.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,867.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,035.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,035.20
|
| Rate for Payer: Multiplan Commercial |
$18,252.00
|
| Rate for Payer: Networks By Design Commercial |
$15,818.40
|
| Rate for Payer: Prime Health Services Commercial |
$20,685.60
|
| Rate for Payer: Riverside University Health System MISP |
$9,734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,601.60
|
| 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 |
$20,685.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,685.60
|
| Rate for Payer: Vantage Medical Group Senior |
$20,685.60
|
|
|
HC EXT CAROTID UNI
|
Facility
|
IP
|
$24,336.00
|
|
|
Service Code
|
CPT 36227
|
| Hospital Charge Code |
906820228
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,867.20 |
| Max. Negotiated Rate |
$21,902.40 |
| Rate for Payer: Adventist Health Commercial |
$4,867.20
|
| Rate for Payer: Cash Price |
$10,951.20
|
| Rate for Payer: Central Health Plan Commercial |
$19,468.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,734.40
|
| Rate for Payer: EPIC Health Plan Senior |
$9,734.40
|
| Rate for Payer: Galaxy Health WC |
$20,685.60
|
| Rate for Payer: Global Benefits Group Commercial |
$14,601.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,902.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,232.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,272.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,063.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,867.20
|
| Rate for Payer: Multiplan Commercial |
$18,252.00
|
| Rate for Payer: Networks By Design Commercial |
$15,818.40
|
| Rate for Payer: Prime Health Services Commercial |
$20,685.60
|
|
|
HC EXT ECG > 48HR TO 21 DAY RCRD
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 0296T
|
| Hospital Charge Code |
900000296
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$554.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$358.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$489.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$315.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.92
|
| Rate for Payer: Blue Shield of California Commercial |
$395.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$554.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$554.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$554.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: InnovAge PACE Commercial |
$326.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$456.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$456.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Riverside University Health System MISP |
$260.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$554.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$554.20
|
| Rate for Payer: Vantage Medical Group Senior |
$554.20
|
|
|
HC EXT ECG > 48HR TO 21 DAY RCRD
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 0296T
|
| Hospital Charge Code |
900000296
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.92
|
| Rate for Payer: Blue Shield of California Commercial |
$395.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: InnovAge PACE Commercial |
$74.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.87
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Prime Health Services Medicare |
$52.86
|
| Rate for Payer: Riverside University Health System MISP |
$54.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$315.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.92
|
| Rate for Payer: Blue Shield of California Commercial |
$395.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$330.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$364.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$24.13 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.92
|
| Rate for Payer: Blue Shield of California Commercial |
$395.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$24.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: InnovAge PACE Commercial |
$74.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.87
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Prime Health Services Medicare |
$52.86
|
| Rate for Payer: Riverside University Health System MISP |
$54.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
OP
|
$652.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$691.00 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$315.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.92
|
| Rate for Payer: Blue Shield of California Commercial |
$395.76
|
| Rate for Payer: Blue Shield of California EPN |
$258.84
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$346.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$382.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$691.00
|
| Rate for Payer: United Healthcare All Other HMO |
$419.00
|
| Rate for Payer: United Healthcare HMO Rider |
$317.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
IP
|
$652.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Adventist Health Commercial |
$130.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: EPIC Health Plan Senior |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$403.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
IP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Central Health Plan Commercial |
$599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.60
|
| Rate for Payer: EPIC Health Plan Senior |
$299.60
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$674.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$463.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
|
|
HC EXTENDED LENGTH TRACH TUBE
|
Facility
|
OP
|
$749.00
|
|
|
Service Code
|
CPT A7520
|
| Hospital Charge Code |
900800707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Adventist Health Commercial |
$149.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$411.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$561.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$362.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$439.89
|
| Rate for Payer: Blue Shield of California Commercial |
$457.64
|
| Rate for Payer: Blue Shield of California EPN |
$298.85
|
| Rate for Payer: Cash Price |
$337.05
|
| Rate for Payer: Central Health Plan Commercial |
$599.20
|
| Rate for Payer: Cigna of CA HMO |
$479.36
|
| Rate for Payer: Cigna of CA PPO |
$554.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$636.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$636.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$636.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.60
|
| Rate for Payer: EPIC Health Plan Senior |
$299.60
|
| Rate for Payer: Galaxy Health WC |
$636.65
|
| Rate for Payer: Global Benefits Group Commercial |
$449.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$674.10
|
| Rate for Payer: InnovAge PACE Commercial |
$374.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$499.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$285.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$463.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$524.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$524.30
|
| Rate for Payer: Multiplan Commercial |
$561.75
|
| Rate for Payer: Networks By Design Commercial |
$486.85
|
| Rate for Payer: Prime Health Services Commercial |
$636.65
|
| Rate for Payer: Riverside University Health System MISP |
$299.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$449.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$449.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$374.50
|
| Rate for Payer: United Healthcare All Other HMO |
$374.50
|
| Rate for Payer: United Healthcare HMO Rider |
$374.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$374.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$636.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$636.65
|
| Rate for Payer: Vantage Medical Group Senior |
$636.65
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
905352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$74.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.30
|
| Rate for Payer: Blue Shield of California Commercial |
$139.91
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.06
|
| Rate for Payer: InnovAge PACE Commercial |
$90.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.70
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$90.50
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Riverside University Health System MISP |
$72.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.85
|
| Rate for Payer: Vantage Medical Group Senior |
$153.85
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
905352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Blue Shield of California Commercial |
$139.91
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
IP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
915352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Blue Shield of California Commercial |
$139.91
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
|
|
HC EXTENDED STEEL SHANK ADDITION LE
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT L2360
|
| Hospital Charge Code |
915352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Adventist Health Commercial |
$74.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$99.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.30
|
| Rate for Payer: Blue Shield of California Commercial |
$139.91
|
| Rate for Payer: Blue Shield of California EPN |
$91.22
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$126.70
|
| Rate for Payer: Cigna of CA PPO |
$126.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$153.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Senior |
$72.40
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$47.06
|
| Rate for Payer: InnovAge PACE Commercial |
$90.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$120.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$126.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$126.70
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$90.50
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Riverside University Health System MISP |
$72.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$108.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.93
|
| Rate for Payer: United Healthcare All Other HMO |
$66.12
|
| Rate for Payer: United Healthcare HMO Rider |
$64.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$153.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$153.85
|
| Rate for Payer: Vantage Medical Group Senior |
$153.85
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Central Health Plan Commercial |
$706.40
|
| Rate for Payer: Cigna of CA HMO |
$565.12
|
| Rate for Payer: Cigna of CA PPO |
$653.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$750.55
|
| Rate for Payer: Global Benefits Group Commercial |
$529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$573.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$750.55
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.50
|
| Rate for Payer: United Healthcare All Other HMO |
$441.50
|
| Rate for Payer: United Healthcare HMO Rider |
$441.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$176.60 |
| Max. Negotiated Rate |
$794.70 |
| Rate for Payer: Adventist Health Commercial |
$176.60
|
| Rate for Payer: Cash Price |
$397.35
|
| Rate for Payer: Central Health Plan Commercial |
$706.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$353.20
|
| Rate for Payer: EPIC Health Plan Senior |
$353.20
|
| Rate for Payer: Galaxy Health WC |
$750.55
|
| Rate for Payer: Global Benefits Group Commercial |
$529.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$794.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$546.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.60
|
| Rate for Payer: Multiplan Commercial |
$662.25
|
| Rate for Payer: Networks By Design Commercial |
$573.95
|
| Rate for Payer: Prime Health Services Commercial |
$750.55
|
|
