|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
IP
|
$10,363.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,072.60 |
| Max. Negotiated Rate |
$9,326.70 |
| Rate for Payer: Adventist Health Commercial |
$2,072.60
|
| Rate for Payer: Cash Price |
$4,663.35
|
| Rate for Payer: Central Health Plan Commercial |
$8,290.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,145.20
|
| Rate for Payer: Galaxy Health WC |
$8,808.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6,217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,326.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,912.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,948.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,414.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,072.60
|
| Rate for Payer: Multiplan Commercial |
$7,772.25
|
| Rate for Payer: Networks By Design Commercial |
$6,735.95
|
| Rate for Payer: Prime Health Services Commercial |
$8,808.55
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906811306
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$177.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$538.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$753.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$487.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$665.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$429.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Central Health Plan Commercial |
$709.60
|
| Rate for Payer: Cigna of CA HMO |
$567.68
|
| Rate for Payer: Cigna of CA PPO |
$656.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$753.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$753.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$753.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$354.80
|
| Rate for Payer: Galaxy Health WC |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$798.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$966.04
|
| Rate for Payer: InnovAge PACE Commercial |
$443.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$591.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,067.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$549.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$620.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$620.90
|
| Rate for Payer: Multiplan Commercial |
$665.25
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
| Rate for Payer: Riverside University Health System MISP |
$354.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$532.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$753.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$753.95
|
| Rate for Payer: Vantage Medical Group Senior |
$753.95
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906811306
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$177.40 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Adventist Health Commercial |
$177.40
|
| Rate for Payer: Cash Price |
$399.15
|
| Rate for Payer: Central Health Plan Commercial |
$709.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$354.80
|
| Rate for Payer: EPIC Health Plan Senior |
$354.80
|
| Rate for Payer: Galaxy Health WC |
$753.95
|
| Rate for Payer: Global Benefits Group Commercial |
$532.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$798.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$591.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$337.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$549.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.40
|
| Rate for Payer: Multiplan Commercial |
$665.25
|
| Rate for Payer: Networks By Design Commercial |
$576.55
|
| Rate for Payer: Prime Health Services Commercial |
$753.95
|
|
|
HC INTRAOP NEURO TESTING, EA 15 MIN
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$210.40 |
| Max. Negotiated Rate |
$946.80 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
|
|
HC INTRAOP NEURO TESTING, EA 15 MIN
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$1,297.00 |
| Rate for Payer: Adventist Health Commercial |
$210.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$638.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$789.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$177.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$617.84
|
| Rate for Payer: Blue Shield of California Commercial |
$638.56
|
| Rate for Payer: Blue Shield of California EPN |
$417.64
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Cash Price |
$473.40
|
| Rate for Payer: Central Health Plan Commercial |
$841.60
|
| Rate for Payer: Cigna of CA HMO |
$673.28
|
| Rate for Payer: Cigna of CA PPO |
$778.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$894.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$894.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.80
|
| Rate for Payer: EPIC Health Plan Senior |
$420.80
|
| Rate for Payer: Galaxy Health WC |
$894.20
|
| Rate for Payer: Global Benefits Group Commercial |
$631.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$946.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.53
|
| Rate for Payer: InnovAge PACE Commercial |
$526.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$651.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$736.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$736.40
|
| Rate for Payer: Multiplan Commercial |
$789.00
|
| Rate for Payer: Networks By Design Commercial |
$683.80
|
| Rate for Payer: Prime Health Services Commercial |
$894.20
|
| Rate for Payer: Riverside University Health System MISP |
$420.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$894.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.20
|
| Rate for Payer: Vantage Medical Group Senior |
$894.20
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
IP
|
$9,433.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,886.60 |
| Max. Negotiated Rate |
$8,489.70 |
| Rate for Payer: Adventist Health Commercial |
$1,886.60
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,546.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,773.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,773.20
|
| Rate for Payer: Galaxy Health WC |
$8,018.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,659.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,489.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,291.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,593.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,839.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,886.60
|
| Rate for Payer: Multiplan Commercial |
$7,074.75
|
| Rate for Payer: Networks By Design Commercial |
$6,131.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,018.05
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
OP
|
$9,433.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,489.70 |
| Rate for Payer: Adventist Health Commercial |
$3,867.53
|
| 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 |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,546.40
|
| Rate for Payer: Cigna of CA HMO |
$6,037.12
|
| Rate for Payer: Cigna of CA PPO |
$6,980.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$8,018.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,659.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,489.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,291.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,886.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$7,074.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$6,131.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,018.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,659.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,659.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
OP
|
$9,433.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,489.70 |
| Rate for Payer: Adventist Health Commercial |
$1,886.60
|
| 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 |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| 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 |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,546.40
|
| Rate for Payer: Cigna of CA HMO |
$6,037.12
|
| Rate for Payer: Cigna of CA PPO |
$6,980.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$8,018.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,659.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,489.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,291.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,886.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$7,074.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$6,131.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,018.05
|
| Rate for Payer: Prime Health Services Medicare |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,659.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,716.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,716.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,716.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,716.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
IP
|
$9,433.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,886.60 |
| Max. Negotiated Rate |
$8,489.70 |
| Rate for Payer: Adventist Health Commercial |
$1,886.60
|
| Rate for Payer: Cash Price |
$4,244.85
|
| Rate for Payer: Central Health Plan Commercial |
$7,546.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,773.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,773.20
|
| Rate for Payer: Galaxy Health WC |
$8,018.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,659.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,489.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,291.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,593.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,839.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,886.60
|
| Rate for Payer: Multiplan Commercial |
$7,074.75
|
| Rate for Payer: Networks By Design Commercial |
$6,131.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,018.05
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
IP
|
$10,189.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,037.80 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,075.60
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,796.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,882.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,306.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
OP
|
$10,189.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$398.96 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$4,177.49
|
| 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 |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$2,998.82
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: Cigna of CA HMO |
$6,520.96
|
| Rate for Payer: Cigna of CA PPO |
$7,539.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,796.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
| Rate for Payer: Prime Health Services Medicare |
$1,995.04
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
OP
|
$10,189.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$398.96 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| 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 |
$2,823.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.11
|
| 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 |
$2,998.82
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: Cigna of CA HMO |
$6,520.96
|
| Rate for Payer: Cigna of CA PPO |
$7,539.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,070.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,882.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,540.85
|
| Rate for Payer: EPIC Health Plan Senior |
$1,882.11
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,086.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,882.11
|
| Rate for Payer: InnovAge PACE Commercial |
$2,823.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,796.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,882.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,522.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,522.03
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,882.11
|
| Rate for Payer: Preferred Health Network WC |
$3,060.02
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
| Rate for Payer: Prime Health Services Medicare |
$1,995.04
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,070.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,094.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,094.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,094.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,094.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,882.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,823.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,070.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,882.11
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
IP
|
$10,189.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,037.80 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,075.60
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,796.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,882.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,306.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
IP
|
$5,819.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,163.80 |
| Max. Negotiated Rate |
$5,237.10 |
| Rate for Payer: Adventist Health Commercial |
$1,163.80
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,655.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,327.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,327.60
|
| Rate for Payer: Galaxy Health WC |
$4,946.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,491.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,237.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,881.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,217.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,601.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.80
|
| Rate for Payer: Multiplan Commercial |
$4,364.25
|
| Rate for Payer: Networks By Design Commercial |
$3,782.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,946.15
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
IP
|
$5,819.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,163.80 |
| Max. Negotiated Rate |
$5,237.10 |
| Rate for Payer: Adventist Health Commercial |
$1,163.80
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,655.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,327.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,327.60
|
| Rate for Payer: Galaxy Health WC |
$4,946.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,491.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,237.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,881.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,217.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,601.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.80
|
| Rate for Payer: Multiplan Commercial |
$4,364.25
|
| Rate for Payer: Networks By Design Commercial |
$3,782.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,946.15
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
OP
|
$5,819.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,163.80
|
| 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 |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,655.20
|
| Rate for Payer: Cigna of CA HMO |
$3,724.16
|
| Rate for Payer: Cigna of CA PPO |
$4,306.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$4,946.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,491.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,237.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,881.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$4,364.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$3,782.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$4,946.15
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,491.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,909.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,909.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,909.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,909.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
OP
|
$5,819.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$2,385.79
|
| 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 |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Cash Price |
$2,618.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,655.20
|
| Rate for Payer: Cigna of CA HMO |
$3,724.16
|
| Rate for Payer: Cigna of CA PPO |
$4,306.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$4,946.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,491.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,237.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,881.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,163.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$4,364.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$3,782.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$4,946.15
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,491.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,491.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$1,934.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$386.80 |
| Max. Negotiated Rate |
$1,740.60 |
| Rate for Payer: Adventist Health Commercial |
$386.80
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,547.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$773.60
|
| Rate for Payer: EPIC Health Plan Senior |
$773.60
|
| Rate for Payer: Galaxy Health WC |
$1,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,160.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,740.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,289.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,197.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.80
|
| Rate for Payer: Multiplan Commercial |
$1,450.50
|
| Rate for Payer: Networks By Design Commercial |
$1,257.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.90
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$1,934.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$386.80
|
| 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 |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| 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 |
$807.84
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,547.20
|
| Rate for Payer: Cigna of CA HMO |
$1,237.76
|
| Rate for Payer: Cigna of CA PPO |
$1,431.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,160.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,740.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,289.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$1,450.50
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$1,257.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.02
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.90
|
| Rate for Payer: Prime Health Services Medicare |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,160.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$967.00
|
| Rate for Payer: United Healthcare All Other HMO |
$967.00
|
| Rate for Payer: United Healthcare HMO Rider |
$967.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$967.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$1,934.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$386.80 |
| Max. Negotiated Rate |
$1,740.60 |
| Rate for Payer: Adventist Health Commercial |
$386.80
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,547.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$773.60
|
| Rate for Payer: EPIC Health Plan Senior |
$773.60
|
| Rate for Payer: Galaxy Health WC |
$1,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,160.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,740.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,289.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$736.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,197.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.80
|
| Rate for Payer: Multiplan Commercial |
$1,450.50
|
| Rate for Payer: Networks By Design Commercial |
$1,257.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.90
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
OP
|
$1,934.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$99.03 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$792.94
|
| 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 |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,135.84
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,547.20
|
| Rate for Payer: Cigna of CA HMO |
$1,237.76
|
| Rate for Payer: Cigna of CA PPO |
$1,431.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,643.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,160.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,740.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,289.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$1,450.50
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$1,257.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.02
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,643.90
|
| Rate for Payer: Prime Health Services Medicare |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,160.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,160.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
IP
|
$12,338.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$11,104.20 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,870.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,104.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,637.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.60
|
| Rate for Payer: Multiplan Commercial |
$9,253.50
|
| Rate for Payer: Networks By Design Commercial |
$8,019.70
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
OP
|
$14,515.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,903.00 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,903.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,028.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,524.66
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,531.75
|
| Rate for Payer: Cash Price |
$6,531.75
|
| Rate for Payer: Cash Price |
$6,531.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,612.00
|
| Rate for Payer: Cigna of CA HMO |
$9,289.60
|
| Rate for Payer: Cigna of CA PPO |
$10,741.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$12,337.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,709.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,063.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,681.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,903.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$10,886.25
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$9,434.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$12,337.75
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,709.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
OP
|
$12,338.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906819764
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,409.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,974.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,246.11
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$22,958.69
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Cash Price |
$5,552.10
|
| Rate for Payer: Central Health Plan Commercial |
$9,870.40
|
| Rate for Payer: Cigna of CA HMO |
$7,896.32
|
| Rate for Payer: Cigna of CA PPO |
$9,130.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,104.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: InnovAge PACE Commercial |
$21,613.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,308.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$9,253.50
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$8,019.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Preferred Health Network WC |
$23,427.23
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: Prime Health Services Medicare |
$15,273.89
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Riverside University Health System MISP |
$15,850.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,402.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC INTRAVASC LITHOTRIPSY
|
Facility
|
IP
|
$14,515.00
|
|
|
Service Code
|
CPT C9764
|
| Hospital Charge Code |
906820312
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,903.00 |
| Max. Negotiated Rate |
$13,063.50 |
| Rate for Payer: Adventist Health Commercial |
$2,903.00
|
| Rate for Payer: Cash Price |
$6,531.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,612.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,806.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,806.00
|
| Rate for Payer: Galaxy Health WC |
$12,337.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,709.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,063.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,681.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,530.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,984.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,903.00
|
| Rate for Payer: Multiplan Commercial |
$10,886.25
|
| Rate for Payer: Networks By Design Commercial |
$9,434.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,337.75
|
|
