|
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 |
$358.60
|
| 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 > 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 |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| 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 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 |
$358.60
|
| 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 |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| 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
|
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 |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| 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 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 |
$358.60
|
| 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 |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| 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 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 |
$358.60
|
| 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 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 |
$358.60
|
| 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 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 |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| Rate for Payer: Cash Price |
$358.60
|
| 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 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 |
$411.95
|
| 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 |
$411.95
|
| 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
|
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 |
$99.55
|
| 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 |
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 |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| 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 |
$99.55
|
| 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 |
$99.55
|
| Rate for Payer: Cash Price |
$99.55
|
| 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 |
$485.65
|
| Rate for Payer: Cash Price |
$485.65
|
| Rate for Payer: Cash Price |
$485.65
|
| Rate for Payer: Cash Price |
$485.65
|
| 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 |
$485.65
|
| 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
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$9,613.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$11,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,922.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,039.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,837.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,407.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,873.54
|
| Rate for Payer: Blue Shield of California EPN |
$3,835.59
|
| Rate for Payer: Cash Price |
$5,287.15
|
| Rate for Payer: Cash Price |
$5,287.15
|
| Rate for Payer: Cash Price |
$5,287.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,690.40
|
| Rate for Payer: Cigna of CA HMO |
$6,152.32
|
| Rate for Payer: Cigna of CA PPO |
$7,113.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$8,171.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,767.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,651.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: InnovAge PACE Commercial |
$6,059.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,411.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,413.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$7,209.75
|
| Rate for Payer: Networks By Design Commercial |
$6,248.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Prime Health Services Commercial |
$8,171.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,282.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,443.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,767.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,767.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$9,613.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,922.60 |
| Max. Negotiated Rate |
$8,651.70 |
| Rate for Payer: Adventist Health Commercial |
$1,922.60
|
| Rate for Payer: Cash Price |
$5,287.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,690.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,845.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,845.20
|
| Rate for Payer: Galaxy Health WC |
$8,171.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,767.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,651.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,411.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,662.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,950.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,922.60
|
| Rate for Payer: Multiplan Commercial |
$7,209.75
|
| Rate for Payer: Networks By Design Commercial |
$6,248.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,171.05
|
|
|
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 |
$85.03
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$60.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| 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 |
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 |
$64.60
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| 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: 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: InnovAge PACE Commercial |
$55.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$64.60
|
| Rate for Payer: Blue Shield of California Commercial |
$85.03
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$60.50
|
| Rate for Payer: Cash Price |
$60.50
|
| 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: 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: InnovAge PACE Commercial |
$55.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$85.03
|
| Rate for Payer: Blue Shield of California EPN |
$55.44
|
| Rate for Payer: Cash Price |
$60.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.09
|
| 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
|
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 |
$861.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,252.80
|
| 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 Permanente of CA Commercial/Self Funded |
$1,044.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$596.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$969.35
|
| 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
|
|
