|
HC INTRACRANIAL ARTL THROMBECTOMY
|
Facility
|
IP
|
$16,905.00
|
|
|
Service Code
|
CPT 61645
|
| Hospital Charge Code |
909061645
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,381.00 |
| Max. Negotiated Rate |
$15,214.50 |
| Rate for Payer: Cash Price |
$7,607.25
|
| Rate for Payer: Central Health Plan Commercial |
$13,524.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,762.00
|
| Rate for Payer: Galaxy Health WC |
$14,369.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,143.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,214.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,440.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,381.00
|
| Rate for Payer: Multiplan Commercial |
$12,678.75
|
| Rate for Payer: Networks By Design Commercial |
$10,988.25
|
| Rate for Payer: Prime Health Services Commercial |
$14,369.25
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
OP
|
$5,370.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$683.14 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,832.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,564.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,953.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,953.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,222.00
|
| Rate for Payer: Blue Shield of California Commercial |
$951.13
|
| Rate for Payer: Blue Shield of California EPN |
$683.14
|
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,296.00
|
| Rate for Payer: Cigna of CA PPO |
$3,973.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,564.50
|
| Rate for Payer: Dignity Health Media |
$4,564.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,564.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,148.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,148.00
|
| Rate for Payer: Galaxy Health WC |
$4,564.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,833.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,027.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,581.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$843.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,074.00
|
| Rate for Payer: Multiplan Commercial |
$4,027.50
|
| Rate for Payer: Networks By Design Commercial |
$3,490.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,564.50
|
| Rate for Payer: Riverside University Health System MISP |
$2,148.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,222.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,564.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,564.50
|
|
|
HC INTRACRANIAL INF NON THROMBO
|
Facility
|
IP
|
$5,370.00
|
|
|
Service Code
|
CPT 61650
|
| Hospital Charge Code |
909061650
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,074.00 |
| Max. Negotiated Rate |
$4,833.00 |
| Rate for Payer: Cash Price |
$2,416.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,296.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,148.00
|
| Rate for Payer: Galaxy Health WC |
$4,564.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,222.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,833.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,581.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,045.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,074.00
|
| Rate for Payer: Multiplan Commercial |
$4,027.50
|
| Rate for Payer: Networks By Design Commercial |
$3,490.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,564.50
|
|
|
HC INTRANASAL BX
|
Facility
|
OP
|
$3,154.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.61 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,905.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,892.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,523.20
|
| Rate for Payer: Cigna of CA PPO |
$2,333.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,838.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,365.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,143.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: InnovAge PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,103.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$2,365.50
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health System MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,892.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INTRANASAL BX
|
Facility
|
IP
|
$3,154.00
|
|
|
Service Code
|
CPT 30100
|
| Hospital Charge Code |
900803395
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$630.80 |
| Max. Negotiated Rate |
$2,838.60 |
| Rate for Payer: Cash Price |
$1,419.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,523.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,261.60
|
| Rate for Payer: Galaxy Health WC |
$2,680.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,892.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,838.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,103.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,201.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$630.80
|
| Rate for Payer: Multiplan Commercial |
$2,365.50
|
| Rate for Payer: Networks By Design Commercial |
$2,050.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,680.90
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
OP
|
$10,908.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$643.00 |
| Max. Negotiated Rate |
$9,817.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$838.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,271.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,999.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,999.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,544.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$4,908.60
|
| Rate for Payer: Cash Price |
$4,908.60
|
| Rate for Payer: Cash Price |
$4,908.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,726.40
|
| Rate for Payer: Cigna of CA HMO |
$6,981.12
|
| Rate for Payer: Cigna of CA PPO |
$8,071.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,271.80
|
| Rate for Payer: Dignity Health Media |
$9,271.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,271.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,363.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,363.20
|
| Rate for Payer: Galaxy Health WC |
$9,271.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,817.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,181.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,817.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,067.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,181.60
|
| Rate for Payer: Multiplan Commercial |
$8,181.00
|
| Rate for Payer: Networks By Design Commercial |
$7,090.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,271.80
|
| Rate for Payer: Riverside University Health System MISP |
$4,363.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,544.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,544.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,271.80
|
| Rate for Payer: Vantage Medical Group Senior |
$9,271.80
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
OP
|
$1,098.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906811306
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$838.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$933.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$603.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$603.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$658.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Central Health Plan Commercial |
$878.40
|
| Rate for Payer: Cigna of CA HMO |
$702.72
|
| Rate for Payer: Cigna of CA PPO |
$812.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$933.30
|
| Rate for Payer: Dignity Health Media |
$933.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$933.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$439.20
|
| Rate for Payer: Galaxy Health WC |
$933.30
|
| Rate for Payer: Global Benefits Group Commercial |
$658.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$988.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$823.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$384.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$732.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,067.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: Networks By Design Commercial |
$713.70
|
| Rate for Payer: Prime Health Services Commercial |
$933.30
|
| Rate for Payer: Riverside University Health System MISP |
$439.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$658.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$658.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$933.30
|
| Rate for Payer: Vantage Medical Group Senior |
$933.30
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
IP
|
$10,908.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906820330
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,181.60 |
| Max. Negotiated Rate |
$9,817.20 |
| Rate for Payer: Cash Price |
$4,908.60
|
| Rate for Payer: Central Health Plan Commercial |
$8,726.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,363.20
|
| Rate for Payer: Galaxy Health WC |
$9,271.80
|
| Rate for Payer: Global Benefits Group Commercial |
$6,544.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,817.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,275.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,155.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,181.60
|
| Rate for Payer: Multiplan Commercial |
$8,181.00
|
| Rate for Payer: Networks By Design Commercial |
$7,090.20
|
| Rate for Payer: Prime Health Services Commercial |
$9,271.80
|
|
|
HC INTRA OP EPICARDIAL/ENDO MAP
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 93631
|
| Hospital Charge Code |
906811306
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$988.20 |
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Central Health Plan Commercial |
$878.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.20
|
| Rate for Payer: Galaxy Health WC |
$933.30
|
| Rate for Payer: Global Benefits Group Commercial |
$658.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$988.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$732.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: Networks By Design Commercial |
$713.70
|
| Rate for Payer: Prime Health Services Commercial |
$933.30
|
|
|
HC INTRAOP NEURO TESTING,PER HOUR
|
Facility
|
IP
|
$1,393.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$278.60 |
| Max. Negotiated Rate |
$1,253.70 |
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,253.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$929.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$530.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$1,044.75
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
|
|
HC INTRAOP NEURO TESTING,PER HOUR
|
Facility
|
OP
|
$1,393.00
|
|
|
Service Code
|
CPT 95940
|
| Hospital Charge Code |
900600299
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$51.40 |
| Max. Negotiated Rate |
$1,253.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$185.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$766.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$177.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$822.98
|
| Rate for Payer: Blue Distinction Transplant |
$835.80
|
| Rate for Payer: Blue Shield of California Commercial |
$860.87
|
| Rate for Payer: Blue Shield of California EPN |
$677.00
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Cash Price |
$626.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,114.40
|
| Rate for Payer: Cigna of CA HMO |
$891.52
|
| Rate for Payer: Cigna of CA PPO |
$1,030.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,184.05
|
| Rate for Payer: Dignity Health Media |
$1,184.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,184.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$557.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$557.20
|
| Rate for Payer: Galaxy Health WC |
$1,184.05
|
| Rate for Payer: Global Benefits Group Commercial |
$835.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,253.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,044.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$487.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$929.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$278.60
|
| Rate for Payer: Multiplan Commercial |
$1,044.75
|
| Rate for Payer: Networks By Design Commercial |
$905.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,184.05
|
| Rate for Payer: Riverside University Health System MISP |
$557.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$835.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$835.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,231.00
|
| Rate for Payer: United Healthcare All Other HMO |
$975.00
|
| Rate for Payer: United Healthcare HMO Rider |
$739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,184.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.05
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
IP
|
$8,635.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,727.00 |
| Max. Negotiated Rate |
$7,771.50 |
| Rate for Payer: Cash Price |
$3,885.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,908.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,454.00
|
| Rate for Payer: Galaxy Health WC |
$7,339.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,181.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,771.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,759.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,289.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,727.00
|
| Rate for Payer: Multiplan Commercial |
$6,476.25
|
| Rate for Payer: Networks By Design Commercial |
$5,612.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,339.75
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
OP
|
$8,635.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$415.93 |
| Max. Negotiated Rate |
$7,771.50 |
| 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 |
$5,181.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,431.42
|
| Rate for Payer: Blue Shield of California EPN |
$4,222.52
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,885.75
|
| Rate for Payer: Cash Price |
$3,885.75
|
| Rate for Payer: Cash Price |
$3,885.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,908.00
|
| Rate for Payer: Cigna of CA HMO |
$5,526.40
|
| Rate for Payer: Cigna of CA PPO |
$6,389.90
|
| 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 |
$7,339.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,181.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,771.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,476.25
|
| 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 |
$5,759.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,727.00
|
| 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 |
$6,476.25
|
| Rate for Payer: Networks By Design Commercial |
$5,612.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,339.75
|
| 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 |
$5,181.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,181.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,317.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,317.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,317.50
|
| 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 INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
IP
|
$8,635.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,727.00 |
| Max. Negotiated Rate |
$7,771.50 |
| Rate for Payer: Cash Price |
$3,885.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,908.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,454.00
|
| Rate for Payer: Galaxy Health WC |
$7,339.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,181.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,771.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,759.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,289.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,727.00
|
| Rate for Payer: Multiplan Commercial |
$6,476.25
|
| Rate for Payer: Networks By Design Commercial |
$5,612.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,339.75
|
|
|
HC INTRAORAL I&D ABSCESS SUBMAND
|
Facility
|
OP
|
$8,635.00
|
|
|
Service Code
|
CPT 41008
|
| Hospital Charge Code |
900501403
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$7,771.50 |
| 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 |
$5,181.00
|
| Rate for Payer: Caremore Medicare Advantage |
$4,022.69
|
| Rate for Payer: Cash Price |
$3,885.75
|
| Rate for Payer: Cash Price |
$3,885.75
|
| Rate for Payer: Cash Price |
$3,885.75
|
| Rate for Payer: Cash Price |
$3,885.75
|
| Rate for Payer: Central Health Plan Commercial |
$6,908.00
|
| Rate for Payer: Cigna of CA PPO |
$6,389.90
|
| 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 |
$7,339.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,181.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,771.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,476.25
|
| 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 |
$5,759.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,022.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,727.00
|
| 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 |
$6,476.25
|
| Rate for Payer: Networks By Design Commercial |
$5,612.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,339.75
|
| 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 |
$5,181.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,317.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,317.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,317.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,317.50
|
| 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 INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
IP
|
$7,704.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,540.80 |
| Max. Negotiated Rate |
$6,933.60 |
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$398.96 |
| Max. Negotiated Rate |
$6,933.60 |
| 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 |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| 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 |
$4,622.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,778.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: InnovAge PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health System MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
IP
|
$7,704.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,540.80 |
| Max. Negotiated Rate |
$6,933.60 |
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,081.60
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,935.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
|
|
HC INTRAORAL I&D OF ABSC LINGUAL
|
Facility
|
OP
|
$7,704.00
|
|
|
Service Code
|
CPT 41007
|
| Hospital Charge Code |
900501146
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$398.96 |
| Max. Negotiated Rate |
$6,933.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,905.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| 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 |
$4,622.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,845.82
|
| Rate for Payer: Blue Shield of California EPN |
$3,767.26
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Cash Price |
$3,466.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,163.20
|
| Rate for Payer: Cigna of CA HMO |
$4,930.56
|
| Rate for Payer: Cigna of CA PPO |
$5,700.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$6,548.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,622.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,933.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,778.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,143.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: InnovAge PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,138.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,540.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$5,778.00
|
| Rate for Payer: Networks By Design Commercial |
$5,007.60
|
| Rate for Payer: Prime Health Services Commercial |
$6,548.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health System MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,622.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,622.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
OP
|
$5,326.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$4,793.40 |
| 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 |
$3,195.60
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,260.80
|
| Rate for Payer: Cigna of CA PPO |
$3,941.24
|
| 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 |
$4,527.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,793.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,994.50
|
| 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 |
$3,552.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.20
|
| 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 |
$3,994.50
|
| Rate for Payer: Networks By Design Commercial |
$3,461.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,527.10
|
| 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 |
$3,195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,663.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,663.00
|
| 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 INTRAORAL INCISION OF ABSCESS
|
Facility
|
OP
|
$5,326.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$4,793.40 |
| 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 |
$3,195.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,350.05
|
| Rate for Payer: Blue Shield of California EPN |
$2,604.41
|
| Rate for Payer: Caremore Medicare Advantage |
$687.44
|
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,260.80
|
| Rate for Payer: Cigna of CA HMO |
$3,408.64
|
| Rate for Payer: Cigna of CA PPO |
$3,941.24
|
| 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 |
$4,527.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,793.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,994.50
|
| 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 |
$3,552.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.20
|
| 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 |
$3,994.50
|
| Rate for Payer: Networks By Design Commercial |
$3,461.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,527.10
|
| 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 |
$3,195.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,195.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,663.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,663.00
|
| 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 INTRAORAL INCISION OF ABSCESS
|
Facility
|
IP
|
$5,326.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,065.20 |
| Max. Negotiated Rate |
$4,793.40 |
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,130.40
|
| Rate for Payer: Galaxy Health WC |
$4,527.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,552.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,029.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.20
|
| Rate for Payer: Multiplan Commercial |
$3,994.50
|
| Rate for Payer: Networks By Design Commercial |
$3,461.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,527.10
|
|
|
HC INTRAORAL INCISION OF ABSCESS
|
Facility
|
IP
|
$5,326.00
|
|
|
Service Code
|
CPT 41000
|
| Hospital Charge Code |
900501290
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,065.20 |
| Max. Negotiated Rate |
$4,793.40 |
| Rate for Payer: Cash Price |
$2,396.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,130.40
|
| Rate for Payer: Galaxy Health WC |
$4,527.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,195.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,793.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,552.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,029.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.20
|
| Rate for Payer: Multiplan Commercial |
$3,994.50
|
| Rate for Payer: Networks By Design Commercial |
$3,461.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,527.10
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
|
HC INTRAOSSEOUS INFUSION
|
Facility
|
IP
|
$1,771.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
900501143
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$354.20 |
| Max. Negotiated Rate |
$1,593.90 |
| Rate for Payer: Cash Price |
$796.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,416.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.40
|
| Rate for Payer: Galaxy Health WC |
$1,505.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,593.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,181.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$1,328.25
|
| Rate for Payer: Networks By Design Commercial |
$1,151.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,505.35
|
|
