|
HC EXT ECG GT 48HR TO 7 DAY RCRD
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
900203242
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.26
|
| Rate for Payer: Blue Distinction Transplant |
$295.80
|
| Rate for Payer: Blue Shield of California Commercial |
$304.67
|
| Rate for Payer: Blue Shield of California EPN |
$239.60
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$369.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: InnovAge PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Riverside University Health System MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$238.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.26
|
| Rate for Payer: Blue Distinction Transplant |
$295.80
|
| Rate for Payer: Blue Shield of California Commercial |
$304.67
|
| Rate for Payer: Blue Shield of California EPN |
$239.60
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$369.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
HC EXT ECG GT 48HR TO 7 DAY RCRD SA
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 93243
|
| Hospital Charge Code |
900203243
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$26.66 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$50.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.26
|
| Rate for Payer: Blue Distinction Transplant |
$295.80
|
| Rate for Payer: Blue Shield of California Commercial |
$304.67
|
| Rate for Payer: Blue Shield of California EPN |
$239.60
|
| Rate for Payer: Caremore Medicare Advantage |
$50.11
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$75.16
|
| Rate for Payer: Dignity Health Media |
$50.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.65
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$50.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.11
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$369.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$82.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$50.11
|
| Rate for Payer: InnovAge PACE Commercial |
$75.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$67.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$67.15
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Prime Health Services Medicare |
$53.12
|
| Rate for Payer: Riverside University Health System MISP |
$55.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$75.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.11
|
|
|
HC EXT ECG GT 7 DAY TO 15 DAY RCRD
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
900203246
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC EXT ECG GT 7 DY TO 15 DY RCRD SA
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 93247
|
| Hospital Charge Code |
900203247
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$656.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$159.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$233.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$238.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$291.26
|
| Rate for Payer: Blue Distinction Transplant |
$295.80
|
| Rate for Payer: Blue Shield of California Commercial |
$304.67
|
| Rate for Payer: Blue Shield of California EPN |
$239.60
|
| Rate for Payer: Caremore Medicare Advantage |
$159.60
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Cash Price |
$221.85
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$239.40
|
| Rate for Payer: Dignity Health Media |
$159.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$175.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.46
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$159.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$159.60
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$369.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$261.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$263.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$159.60
|
| Rate for Payer: InnovAge PACE Commercial |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$159.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$213.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$213.86
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Prime Health Services Medicare |
$169.18
|
| Rate for Payer: Riverside University Health System MISP |
$175.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$656.00
|
| Rate for Payer: United Healthcare All Other HMO |
$399.00
|
| Rate for Payer: United Healthcare HMO Rider |
$302.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$276.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$239.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$175.56
|
| Rate for Payer: Vantage Medical Group Senior |
$159.60
|
|
|
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: 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: 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: 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 |
$124.68 |
| Max. Negotiated Rate |
$674.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.68
|
| 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 |
$411.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$362.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$442.51
|
| Rate for Payer: Blue Distinction Transplant |
$449.40
|
| Rate for Payer: Blue Shield of California Commercial |
$471.12
|
| Rate for Payer: Blue Shield of California EPN |
$366.26
|
| Rate for Payer: Cash Price |
$337.05
|
| 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 Media |
$636.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$636.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$299.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$561.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$262.15
|
| 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: 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
|
| 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 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 |
905352360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.20 |
| Max. Negotiated Rate |
$162.90 |
| Rate for Payer: Blue Shield of California EPN |
$96.65
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$36.20
|
| 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: United Healthcare All Other Commercial |
$68.35
|
| Rate for Payer: United Healthcare All Other HMO |
$66.75
|
| Rate for Payer: United Healthcare HMO Rider |
$65.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.73
|
|
|
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 |
$51.98 |
| Max. Negotiated Rate |
$162.90 |
| 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 |
$99.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$87.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.93
|
| Rate for Payer: Blue Distinction Transplant |
$108.60
|
| Rate for Payer: Blue Shield of California Commercial |
$135.75
|
| Rate for Payer: Blue Shield of California EPN |
$98.46
|
| 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 Media |
$153.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$153.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$135.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.35
|
| 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: LLUH Dept of Risk Management WC |
$74.21
|
| 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 |
$90.50
|
| Rate for Payer: United Healthcare All Other HMO |
$90.50
|
| Rate for Payer: United Healthcare HMO Rider |
$90.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$90.50
|
| 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
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$601.20 |
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.20
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
|
|
HC EXTERNAL EAR, UNLISTED PROCEDU
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 69399
|
| Hospital Charge Code |
900501298
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$133.60 |
| Max. Negotiated Rate |
$2,696.00 |
| 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 |
$457.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$305.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$400.80
|
| Rate for Payer: Caremore Medicare Advantage |
$305.19
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Cash Price |
$300.60
|
| Rate for Payer: Central Health Plan Commercial |
$534.40
|
| Rate for Payer: Cigna of CA PPO |
$494.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$457.78
|
| Rate for Payer: Dignity Health Media |
$305.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$412.01
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$305.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$305.19
|
| Rate for Payer: Galaxy Health WC |
$567.80
|
| Rate for Payer: Global Benefits Group Commercial |
$400.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$501.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$500.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$305.19
|
| Rate for Payer: InnovAge PACE Commercial |
$457.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$408.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$408.95
|
| Rate for Payer: Multiplan Commercial |
$501.00
|
| Rate for Payer: Networks By Design Commercial |
$434.20
|
| Rate for Payer: Prime Health Services Commercial |
$567.80
|
| Rate for Payer: Prime Health Services Medicare |
$323.50
|
| Rate for Payer: Riverside University Health System MISP |
$335.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.00
|
| Rate for Payer: United Healthcare All Other HMO |
$334.00
|
| Rate for Payer: United Healthcare HMO Rider |
$334.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$334.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$457.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.71
|
| Rate for Payer: Vantage Medical Group Senior |
$305.19
|
|
|
HC EXTERNAL VERSION
|
Facility
|
OP
|
$7,269.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$524.11 |
| Max. Negotiated Rate |
$10,256.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$3,906.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$524.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,906.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,407.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,256.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,361.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,572.20
|
| Rate for Payer: Blue Shield of California EPN |
$3,554.54
|
| Rate for Payer: Caremore Medicare Advantage |
$3,906.18
|
| Rate for Payer: Cash Price |
$3,271.05
|
| Rate for Payer: Cash Price |
$3,271.05
|
| Rate for Payer: Cash Price |
$3,271.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,815.20
|
| Rate for Payer: Cigna of CA HMO |
$4,652.16
|
| Rate for Payer: Cigna of CA PPO |
$5,379.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Dignity Health Media |
$3,906.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,296.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,273.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$3,906.18
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,906.18
|
| Rate for Payer: Galaxy Health WC |
$6,178.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,361.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,542.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,451.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,406.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,445.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,906.18
|
| Rate for Payer: InnovAge PACE Commercial |
$5,859.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,848.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,769.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,906.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,453.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,234.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,234.28
|
| Rate for Payer: Multiplan Commercial |
$5,451.75
|
| Rate for Payer: Networks By Design Commercial |
$4,724.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,178.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,140.55
|
| Rate for Payer: Riverside University Health System MISP |
$4,296.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,361.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,361.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,859.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,296.80
|
| Rate for Payer: Vantage Medical Group Senior |
$3,906.18
|
|
|
HC EXTERNAL VERSION
|
Facility
|
IP
|
$7,269.00
|
|
|
Service Code
|
CPT 59412
|
| Hospital Charge Code |
902400105
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,453.80 |
| Max. Negotiated Rate |
$6,542.10 |
| Rate for Payer: Cash Price |
$3,271.05
|
| Rate for Payer: Central Health Plan Commercial |
$5,815.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,907.60
|
| Rate for Payer: Galaxy Health WC |
$6,178.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,361.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,542.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,848.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,769.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,453.80
|
| Rate for Payer: Multiplan Commercial |
$5,451.75
|
| Rate for Payer: Networks By Design Commercial |
$4,724.85
|
| Rate for Payer: Prime Health Services Commercial |
$6,178.65
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
IP
|
$1,434.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$286.80 |
| Max. Negotiated Rate |
$1,290.60 |
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.60
|
| Rate for Payer: Galaxy Health WC |
$1,218.90
|
| Rate for Payer: Global Benefits Group Commercial |
$860.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,290.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$956.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.80
|
| Rate for Payer: Multiplan Commercial |
$1,075.50
|
| Rate for Payer: Networks By Design Commercial |
$932.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.90
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
OP
|
$1,434.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$254.66 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$860.40
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,147.20
|
| Rate for Payer: Cigna of CA PPO |
$1,061.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$1,218.90
|
| Rate for Payer: Global Benefits Group Commercial |
$860.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,290.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,075.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: InnovAge PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$956.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$1,075.50
|
| Rate for Payer: Networks By Design Commercial |
$932.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.90
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Riverside University Health System MISP |
$756.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$860.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$717.00
|
| Rate for Payer: United Healthcare All Other HMO |
$717.00
|
| Rate for Payer: United Healthcare HMO Rider |
$717.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$717.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
OP
|
$1,434.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$254.66 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$687.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$687.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$860.40
|
| Rate for Payer: Blue Shield of California Commercial |
$901.99
|
| Rate for Payer: Blue Shield of California EPN |
$701.23
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,147.20
|
| Rate for Payer: Cigna of CA HMO |
$917.76
|
| Rate for Payer: Cigna of CA PPO |
$1,061.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Dignity Health Media |
$687.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$928.04
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$687.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$687.44
|
| Rate for Payer: Galaxy Health WC |
$1,218.90
|
| Rate for Payer: Global Benefits Group Commercial |
$860.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,290.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,075.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,127.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,134.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$687.44
|
| Rate for Payer: InnovAge PACE Commercial |
$1,031.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$956.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$921.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$921.17
|
| Rate for Payer: Multiplan Commercial |
$1,075.50
|
| Rate for Payer: Networks By Design Commercial |
$932.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.90
|
| Rate for Payer: Prime Health Services Medicare |
$728.69
|
| Rate for Payer: Riverside University Health System MISP |
$756.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$860.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$860.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$717.00
|
| Rate for Payer: United Healthcare All Other HMO |
$717.00
|
| Rate for Payer: United Healthcare HMO Rider |
$717.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$717.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.18
|
| Rate for Payer: Vantage Medical Group Senior |
$687.44
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBLINGL
|
Facility
|
IP
|
$1,434.00
|
|
|
Service Code
|
CPT 41015
|
| Hospital Charge Code |
900500015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$286.80 |
| Max. Negotiated Rate |
$1,290.60 |
| Rate for Payer: Cash Price |
$645.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,147.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$573.60
|
| Rate for Payer: Galaxy Health WC |
$1,218.90
|
| Rate for Payer: Global Benefits Group Commercial |
$860.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,290.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$956.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$546.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$286.80
|
| Rate for Payer: Multiplan Commercial |
$1,075.50
|
| Rate for Payer: Networks By Design Commercial |
$932.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,218.90
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
IP
|
$4,941.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$988.20 |
| Max. Negotiated Rate |
$4,446.90 |
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,952.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,976.40
|
| Rate for Payer: Galaxy Health WC |
$4,199.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,964.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,446.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,882.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.20
|
| Rate for Payer: Multiplan Commercial |
$3,705.75
|
| Rate for Payer: Networks By Design Commercial |
$3,211.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,199.85
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
OP
|
$4,941.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,597.21 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,964.60
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,952.80
|
| Rate for Payer: Cigna of CA PPO |
$3,656.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$4,199.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,964.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,446.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,705.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$3,705.75
|
| Rate for Payer: Networks By Design Commercial |
$3,211.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,199.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,964.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,470.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,470.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,470.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,470.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
OP
|
$4,941.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$481.00 |
| Max. Negotiated Rate |
$6,637.44 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,022.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,022.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,964.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,107.89
|
| Rate for Payer: Blue Shield of California EPN |
$2,416.15
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,952.80
|
| Rate for Payer: Cigna of CA HMO |
$3,162.24
|
| Rate for Payer: Cigna of CA PPO |
$3,656.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Dignity Health Media |
$4,022.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,424.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,430.63
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,022.69
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,022.69
|
| Rate for Payer: Galaxy Health WC |
$4,199.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,964.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,446.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,705.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,597.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,637.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,022.69
|
| Rate for Payer: InnovAge PACE Commercial |
$6,034.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,390.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,390.40
|
| Rate for Payer: Multiplan Commercial |
$3,705.75
|
| Rate for Payer: Networks By Design Commercial |
$3,211.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,199.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,264.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,424.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,964.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,964.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,470.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,470.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,470.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,470.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,034.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,424.96
|
| Rate for Payer: Vantage Medical Group Senior |
$4,022.69
|
|
|
HC EXTRAORAL I&D ABSCESS,SUBMANDI
|
Facility
|
IP
|
$4,941.00
|
|
|
Service Code
|
CPT 41017
|
| Hospital Charge Code |
900501410
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$988.20 |
| Max. Negotiated Rate |
$4,446.90 |
| Rate for Payer: Cash Price |
$2,223.45
|
| Rate for Payer: Central Health Plan Commercial |
$3,952.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,976.40
|
| Rate for Payer: Galaxy Health WC |
$4,199.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,964.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,446.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,882.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$988.20
|
| Rate for Payer: Multiplan Commercial |
$3,705.75
|
| Rate for Payer: Networks By Design Commercial |
$3,211.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,199.85
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
IP
|
$1,170.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
900803201
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,053.00 |
| Rate for Payer: Cash Price |
$526.50
|
| Rate for Payer: Central Health Plan Commercial |
$936.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$468.00
|
| Rate for Payer: Galaxy Health WC |
$994.50
|
| Rate for Payer: Global Benefits Group Commercial |
$702.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,053.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$780.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$445.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$877.50
|
| Rate for Payer: Networks By Design Commercial |
$760.50
|
| Rate for Payer: Prime Health Services Commercial |
$994.50
|
|
|
HC EXTREMITY STUDY COMPLEX
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
908100119
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$343.80 |
| Max. Negotiated Rate |
$1,547.10 |
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.60
|
| Rate for Payer: Galaxy Health WC |
$1,461.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,031.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,547.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,146.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.80
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: Networks By Design Commercial |
$1,117.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,461.15
|
|
