|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
IP
|
$15,274.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,054.80 |
| Max. Negotiated Rate |
$13,746.60 |
| Rate for Payer: Cash Price |
$6,873.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,219.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,109.60
|
| Rate for Payer: Galaxy Health WC |
$12,982.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,746.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,819.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,054.80
|
| Rate for Payer: Multiplan Commercial |
$11,455.50
|
| Rate for Payer: Networks By Design Commercial |
$9,928.10
|
| Rate for Payer: Prime Health Services Commercial |
$12,982.90
|
|
|
HC OPEN TREAT METATARSAL FX, EA
|
Facility
|
OP
|
$15,274.00
|
|
|
Service Code
|
CPT 28485
|
| Hospital Charge Code |
900501691
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$9,164.40
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$6,873.30
|
| Rate for Payer: Cash Price |
$6,873.30
|
| Rate for Payer: Cash Price |
$6,873.30
|
| Rate for Payer: Cash Price |
$6,873.30
|
| Rate for Payer: Central Health Plan Commercial |
$12,219.20
|
| Rate for Payer: Cigna of CA PPO |
$11,302.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$12,982.90
|
| Rate for Payer: Global Benefits Group Commercial |
$9,164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,746.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11,455.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,187.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$891.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,054.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$11,455.50
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$9,928.10
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$12,982.90
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,637.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,637.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,637.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,637.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
IP
|
$10,200.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,040.00 |
| Max. Negotiated Rate |
$9,180.00 |
| Rate for Payer: Cash Price |
$4,590.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,080.00
|
| Rate for Payer: Galaxy Health WC |
$8,670.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,180.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,803.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,886.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,040.00
|
| Rate for Payer: Multiplan Commercial |
$7,650.00
|
| Rate for Payer: Networks By Design Commercial |
$6,630.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,670.00
|
|
|
HC OPEN TREAT TALUS FRACTURE
|
Facility
|
OP
|
$10,200.00
|
|
|
Service Code
|
CPT 28445
|
| Hospital Charge Code |
900501370
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$14,659.19 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,938.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,220.24
|
| Rate for Payer: Blue Distinction Transplant |
$6,120.00
|
| Rate for Payer: Caremore Medicare Advantage |
$8,938.53
|
| Rate for Payer: Cash Price |
$4,590.00
|
| Rate for Payer: Cash Price |
$4,590.00
|
| Rate for Payer: Cash Price |
$4,590.00
|
| Rate for Payer: Cash Price |
$4,590.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,160.00
|
| Rate for Payer: Cigna of CA PPO |
$7,548.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Dignity Health Media |
$8,938.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,832.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,067.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8,938.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,938.53
|
| Rate for Payer: Galaxy Health WC |
$8,670.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,180.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,650.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14,659.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,938.53
|
| Rate for Payer: InnovAge PACE Commercial |
$13,407.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,803.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,938.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,040.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,977.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,977.63
|
| Rate for Payer: Multiplan Commercial |
$7,650.00
|
| Rate for Payer: Multiplan WC |
$12,220.24
|
| Rate for Payer: Networks By Design Commercial |
$6,630.00
|
| Rate for Payer: Preferred Health Network WC |
$12,469.63
|
| Rate for Payer: Prime Health Services Commercial |
$8,670.00
|
| Rate for Payer: Prime Health Services Medicare |
$9,474.84
|
| Rate for Payer: Prime Health Services WC |
$12,095.54
|
| Rate for Payer: Riverside University Health System MISP |
$9,832.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,100.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,100.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,100.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,100.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,407.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,832.38
|
| Rate for Payer: Vantage Medical Group Senior |
$8,938.53
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$986.40 |
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC OPERATING MICROSCOPE
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 69990
|
| Hospital Charge Code |
900501663
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$931.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$602.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$602.80
|
| 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 |
$657.60
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Central Health Plan Commercial |
$876.80
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$931.60
|
| Rate for Payer: Dignity Health Media |
$931.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$931.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$986.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$822.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$348.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.20
|
| Rate for Payer: Multiplan Commercial |
$822.00
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Riverside University Health System MISP |
$438.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$931.60
|
| Rate for Payer: Vantage Medical Group Senior |
$931.60
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.54 |
| Max. Negotiated Rate |
$1,257.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$253.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$676.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$825.35
|
| Rate for Payer: Blue Distinction Transplant |
$838.20
|
| Rate for Payer: Blue Shield of California Commercial |
$863.35
|
| Rate for Payer: Blue Shield of California EPN |
$678.94
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,117.60
|
| Rate for Payer: Cigna of CA HMO |
$894.08
|
| Rate for Payer: Cigna of CA PPO |
$1,033.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,257.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,047.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$1,047.75
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$838.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$838.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC OPERATIVE ANGIOGRAM
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
CPT 76499
|
| Hospital Charge Code |
909001054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$279.40 |
| Max. Negotiated Rate |
$1,257.30 |
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.80
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,257.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$279.40
|
| Rate for Payer: Multiplan Commercial |
$1,047.75
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.08 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$113.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$253.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$173.72
|
| Rate for Payer: Blue Distinction Transplant |
$276.00
|
| Rate for Payer: Blue Shield of California Commercial |
$284.28
|
| Rate for Payer: Blue Shield of California EPN |
$223.56
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$294.40
|
| Rate for Payer: Cigna of CA PPO |
$340.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.00
|
| Rate for Payer: Dignity Health Media |
$391.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$345.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$161.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Riverside University Health System MISP |
$184.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC OPERATIVE CHOLANGIO, ADDL FILM
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 74301
|
| Hospital Charge Code |
909001826
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
IP
|
$876.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.20 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Central Health Plan Commercial |
$700.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.40
|
| Rate for Payer: Galaxy Health WC |
$744.60
|
| Rate for Payer: Global Benefits Group Commercial |
$525.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$788.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$333.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Multiplan Commercial |
$657.00
|
| Rate for Payer: Networks By Design Commercial |
$569.40
|
| Rate for Payer: Prime Health Services Commercial |
$744.60
|
|
|
HC OPERATIVE CHOLANGIOG
|
Facility
|
OP
|
$876.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
909001827
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.23 |
| Max. Negotiated Rate |
$788.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$186.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$744.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$481.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.80
|
| Rate for Payer: Blue Distinction Transplant |
$525.60
|
| Rate for Payer: Blue Shield of California Commercial |
$541.37
|
| Rate for Payer: Blue Shield of California EPN |
$425.74
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Central Health Plan Commercial |
$700.80
|
| Rate for Payer: Cigna of CA HMO |
$560.64
|
| Rate for Payer: Cigna of CA PPO |
$648.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$744.60
|
| Rate for Payer: Dignity Health Media |
$744.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$744.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$350.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$350.40
|
| Rate for Payer: Galaxy Health WC |
$744.60
|
| Rate for Payer: Global Benefits Group Commercial |
$525.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$788.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$657.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$306.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$584.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$175.20
|
| Rate for Payer: Multiplan Commercial |
$657.00
|
| Rate for Payer: Networks By Design Commercial |
$569.40
|
| Rate for Payer: Prime Health Services Commercial |
$744.60
|
| Rate for Payer: Riverside University Health System MISP |
$350.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$525.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$525.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$438.00
|
| Rate for Payer: United Healthcare All Other HMO |
$438.00
|
| Rate for Payer: United Healthcare HMO Rider |
$438.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$438.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$744.60
|
| Rate for Payer: Vantage Medical Group Senior |
$744.60
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
IP
|
$12,220.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,444.00 |
| Max. Negotiated Rate |
$10,998.00 |
| Rate for Payer: Cash Price |
$5,499.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,776.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,888.00
|
| Rate for Payer: Galaxy Health WC |
$10,387.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,332.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,998.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,655.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.00
|
| Rate for Payer: Multiplan Commercial |
$9,165.00
|
| Rate for Payer: Networks By Design Commercial |
$7,943.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,387.00
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
OP
|
$12,220.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$10,998.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,120.62
|
| 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 |
$7,332.00
|
| Rate for Payer: Caremore Medicare Advantage |
$2,120.62
|
| Rate for Payer: Cash Price |
$5,499.00
|
| Rate for Payer: Cash Price |
$5,499.00
|
| Rate for Payer: Cash Price |
$5,499.00
|
| Rate for Payer: Cash Price |
$5,499.00
|
| Rate for Payer: Central Health Plan Commercial |
$9,776.00
|
| Rate for Payer: Cigna of CA PPO |
$9,042.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Dignity Health Media |
$2,120.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,332.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,862.84
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,120.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,120.62
|
| Rate for Payer: Galaxy Health WC |
$10,387.00
|
| Rate for Payer: Global Benefits Group Commercial |
$7,332.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,998.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,165.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,477.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,120.62
|
| Rate for Payer: InnovAge PACE Commercial |
$3,180.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,120.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,444.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,841.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,841.63
|
| Rate for Payer: Multiplan Commercial |
$9,165.00
|
| Rate for Payer: Networks By Design Commercial |
$7,943.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,387.00
|
| Rate for Payer: Prime Health Services Medicare |
$2,247.86
|
| Rate for Payer: Riverside University Health System MISP |
$2,332.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,332.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,110.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,110.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,110.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,110.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,180.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,332.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,120.62
|
|
|
HC OP EXTEND RECOVERY ADDL 30 MIN
|
Facility
|
IP
|
$142.00
|
|
| Hospital Charge Code |
988100100
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC OP EXTEND RECOVERY ADDL 30 MIN
|
Facility
|
OP
|
$142.00
|
|
| Hospital Charge Code |
988100100
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$127.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$86.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$120.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$68.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.89
|
| Rate for Payer: Blue Distinction Transplant |
$85.20
|
| Rate for Payer: Blue Shield of California Commercial |
$89.32
|
| Rate for Payer: Blue Shield of California EPN |
$69.44
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$120.70
|
| Rate for Payer: Dignity Health Media |
$120.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$120.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$106.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$49.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$94.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Riverside University Health System MISP |
$56.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71.00
|
| Rate for Payer: United Healthcare HMO Rider |
$71.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$120.70
|
| Rate for Payer: Vantage Medical Group Senior |
$120.70
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.87 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$319.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.95
|
| Rate for Payer: Blue Distinction Transplant |
$250.80
|
| Rate for Payer: Blue Shield of California Commercial |
$258.32
|
| Rate for Payer: Blue Shield of California EPN |
$203.15
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| Rate for Payer: Cigna of CA HMO |
$267.52
|
| Rate for Payer: Cigna of CA PPO |
$309.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$313.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$278.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: Networks By Design Commercial |
$271.70
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC OPIATES CONF & ID
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.60
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Media |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Riverside University Health System MISP |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.50
|
| Rate for Payer: United Healthcare All Other HMO |
$112.50
|
| Rate for Payer: United Healthcare HMO Rider |
$112.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC OPIATES CONF & ID
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC OPN FEM ART DELV END PRO, UNI
|
Facility
|
IP
|
$6,556.00
|
|
|
Service Code
|
CPT 34812
|
| Hospital Charge Code |
900034812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,311.20 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,950.20
|
| Rate for Payer: Cash Price |
$2,950.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,244.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.40
|
| Rate for Payer: Galaxy Health WC |
$5,572.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,900.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,497.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,311.20
|
| Rate for Payer: Multiplan Commercial |
$4,917.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,572.60
|
|
|
HC OPN FEM ART DELV END PRO, UNI
|
Facility
|
OP
|
$6,556.00
|
|
|
Service Code
|
CPT 34812
|
| Hospital Charge Code |
900034812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$120.95 |
| Max. Negotiated Rate |
$7,830.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,829.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,572.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,605.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,605.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,830.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,933.60
|
| 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 |
$2,950.20
|
| Rate for Payer: Cash Price |
$2,950.20
|
| Rate for Payer: Cash Price |
$2,950.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,244.80
|
| Rate for Payer: Cigna of CA PPO |
$4,851.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,572.60
|
| Rate for Payer: Dignity Health Media |
$5,572.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,572.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,622.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,622.40
|
| Rate for Payer: Galaxy Health WC |
$5,572.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,933.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,900.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,917.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,294.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,311.20
|
| Rate for Payer: Multiplan Commercial |
$4,917.00
|
| Rate for Payer: Networks By Design Commercial |
$4,261.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,572.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,622.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,933.60
|
| 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 |
$5,572.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,572.60
|
|
|
HC OP SVC LEVEL I 1ST HR
|
Facility
|
OP
|
$704.00
|
|
| Hospital Charge Code |
909401010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$427.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$598.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$387.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$340.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$415.92
|
| Rate for Payer: Blue Distinction Transplant |
$422.40
|
| 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 |
$316.80
|
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| Rate for Payer: Cigna of CA PPO |
$520.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$598.40
|
| Rate for Payer: Dignity Health Media |
$598.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$598.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$281.60
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$633.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$528.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$246.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
| Rate for Payer: Riverside University Health System MISP |
$281.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$422.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$352.00
|
| Rate for Payer: United Healthcare All Other HMO |
$352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$352.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$352.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$598.40
|
| Rate for Payer: Vantage Medical Group Senior |
$598.40
|
|
|
HC OP SVC LEVEL I 1ST HR
|
Facility
|
IP
|
$704.00
|
|
| Hospital Charge Code |
909401010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$140.80 |
| Max. Negotiated Rate |
$633.60 |
| Rate for Payer: Cash Price |
$316.80
|
| Rate for Payer: Central Health Plan Commercial |
$563.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$281.60
|
| Rate for Payer: Galaxy Health WC |
$598.40
|
| Rate for Payer: Global Benefits Group Commercial |
$422.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$469.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.80
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$457.60
|
| Rate for Payer: Prime Health Services Commercial |
$598.40
|
|
|
HC OP SVC LEVEL I 1ST SUBSEQ HALF HR
|
Facility
|
OP
|
$356.00
|
|
| Hospital Charge Code |
909401011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$216.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$302.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$195.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$195.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$172.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$210.32
|
| Rate for Payer: Blue Distinction Transplant |
$213.60
|
| 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 |
$160.20
|
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Central Health Plan Commercial |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$263.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$302.60
|
| Rate for Payer: Dignity Health Media |
$302.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$302.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$142.40
|
| Rate for Payer: Galaxy Health WC |
$302.60
|
| Rate for Payer: Global Benefits Group Commercial |
$213.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$320.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$267.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$124.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.20
|
| Rate for Payer: Multiplan Commercial |
$267.00
|
| Rate for Payer: Networks By Design Commercial |
$231.40
|
| Rate for Payer: Prime Health Services Commercial |
$302.60
|
| Rate for Payer: Riverside University Health System MISP |
$142.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$213.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$178.00
|
| Rate for Payer: United Healthcare All Other HMO |
$178.00
|
| Rate for Payer: United Healthcare HMO Rider |
$178.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$178.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$302.60
|
| Rate for Payer: Vantage Medical Group Senior |
$302.60
|
|
