|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
905353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$60.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.09
|
| Rate for Payer: Blue Shield of California Commercial |
$118.70
|
| Rate for Payer: Blue Shield of California EPN |
$74.59
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103.60
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Riverside University Health System MISP |
$59.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.80
|
| Rate for Payer: Vantage Medical Group Senior |
$125.80
|
|
|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
915353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$60.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$86.09
|
| Rate for Payer: Blue Shield of California Commercial |
$118.70
|
| Rate for Payer: Blue Shield of California EPN |
$74.59
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$103.60
|
| Rate for Payer: Cigna of CA PPO |
$103.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$125.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.20
|
| Rate for Payer: EPIC Health Plan Senior |
$59.20
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103.60
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$74.00
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Riverside University Health System MISP |
$59.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.54
|
| Rate for Payer: United Healthcare All Other HMO |
$54.06
|
| Rate for Payer: United Healthcare HMO Rider |
$52.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125.80
|
| Rate for Payer: Vantage Medical Group Senior |
$125.80
|
|
|
HC SHTH PERCUTANEOUS 6FR
|
Facility
|
OP
|
$232.40
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Adventist Health Commercial |
$46.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.19
|
| Rate for Payer: Blue Shield of California Commercial |
$147.34
|
| Rate for Payer: Blue Shield of California EPN |
$92.73
|
| Rate for Payer: Cash Price |
$104.58
|
| Rate for Payer: Cash Price |
$104.58
|
| Rate for Payer: Central Health Plan Commercial |
$185.92
|
| Rate for Payer: Cigna of CA HMO |
$148.74
|
| Rate for Payer: Cigna of CA PPO |
$171.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.96
|
| Rate for Payer: EPIC Health Plan Senior |
$92.96
|
| Rate for Payer: Galaxy Health WC |
$197.54
|
| Rate for Payer: Global Benefits Group Commercial |
$139.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$162.68
|
| Rate for Payer: Multiplan Commercial |
$174.30
|
| Rate for Payer: Networks By Design Commercial |
$151.06
|
| Rate for Payer: Prime Health Services Commercial |
$197.54
|
| Rate for Payer: Riverside University Health System MISP |
$92.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.20
|
| Rate for Payer: United Healthcare All Other HMO |
$116.20
|
| Rate for Payer: United Healthcare HMO Rider |
$116.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.54
|
| Rate for Payer: Vantage Medical Group Senior |
$197.54
|
|
|
HC SHTH PERCUTANEOUS 6FR
|
Facility
|
IP
|
$232.40
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901602584
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.48 |
| Max. Negotiated Rate |
$209.16 |
| Rate for Payer: Adventist Health Commercial |
$46.48
|
| Rate for Payer: Cash Price |
$104.58
|
| Rate for Payer: Central Health Plan Commercial |
$185.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$162.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.96
|
| Rate for Payer: EPIC Health Plan Senior |
$92.96
|
| Rate for Payer: Galaxy Health WC |
$197.54
|
| Rate for Payer: Global Benefits Group Commercial |
$139.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$147.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$137.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.48
|
| Rate for Payer: Multiplan Commercial |
$174.30
|
| Rate for Payer: Networks By Design Commercial |
$151.06
|
| Rate for Payer: Prime Health Services Commercial |
$197.54
|
|
|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
|
OP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$235.49 |
| Rate for Payer: Adventist Health Commercial |
$43.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$161.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$104.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$125.29
|
| Rate for Payer: Blue Shield of California Commercial |
$136.56
|
| Rate for Payer: Blue Shield of California EPN |
$85.94
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Central Health Plan Commercial |
$172.31
|
| Rate for Payer: Cigna of CA HMO |
$137.85
|
| Rate for Payer: Cigna of CA PPO |
$159.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: EPIC Health Plan Senior |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$150.77
|
| Rate for Payer: Multiplan Commercial |
$161.54
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
| Rate for Payer: Riverside University Health System MISP |
$86.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.69
|
| Rate for Payer: United Healthcare All Other HMO |
$107.69
|
| Rate for Payer: United Healthcare HMO Rider |
$107.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.08
|
| Rate for Payer: Vantage Medical Group Senior |
$183.08
|
|
|
HC SHTH PERCUTANEOUS 8.5FR
|
Facility
|
IP
|
$215.39
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901601764
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.08 |
| Max. Negotiated Rate |
$193.85 |
| Rate for Payer: Adventist Health Commercial |
$43.08
|
| Rate for Payer: Cash Price |
$96.93
|
| Rate for Payer: Central Health Plan Commercial |
$172.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$150.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.16
|
| Rate for Payer: EPIC Health Plan Senior |
$86.16
|
| Rate for Payer: Galaxy Health WC |
$183.08
|
| Rate for Payer: Global Benefits Group Commercial |
$129.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$193.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$136.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.08
|
| Rate for Payer: Multiplan Commercial |
$161.54
|
| Rate for Payer: Networks By Design Commercial |
$140.00
|
| Rate for Payer: Prime Health Services Commercial |
$183.08
|
|
|
HC SHTH PERCUTANEOUS INTRO 8.5FR
|
Facility
|
OP
|
$348.60
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$313.74 |
| Rate for Payer: Adventist Health Commercial |
$69.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.78
|
| Rate for Payer: Blue Shield of California Commercial |
$221.01
|
| Rate for Payer: Blue Shield of California EPN |
$139.09
|
| Rate for Payer: Cash Price |
$156.87
|
| Rate for Payer: Cash Price |
$156.87
|
| Rate for Payer: Central Health Plan Commercial |
$278.88
|
| Rate for Payer: Cigna of CA HMO |
$223.10
|
| Rate for Payer: Cigna of CA PPO |
$257.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$296.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$296.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$244.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Senior |
$139.44
|
| Rate for Payer: Galaxy Health WC |
$296.31
|
| Rate for Payer: Global Benefits Group Commercial |
$209.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$313.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$221.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$126.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$205.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$244.02
|
| Rate for Payer: Multiplan Commercial |
$261.45
|
| Rate for Payer: Networks By Design Commercial |
$226.59
|
| Rate for Payer: Prime Health Services Commercial |
$296.31
|
| Rate for Payer: Riverside University Health System MISP |
$139.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$209.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$209.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.30
|
| Rate for Payer: United Healthcare All Other HMO |
$174.30
|
| Rate for Payer: United Healthcare HMO Rider |
$174.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$296.31
|
| Rate for Payer: Vantage Medical Group Senior |
$296.31
|
|
|
HC SHTH PERCUTANEOUS INTRO 8.5FR
|
Facility
|
IP
|
$348.60
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901698290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$313.74 |
| Rate for Payer: Adventist Health Commercial |
$69.72
|
| Rate for Payer: Cash Price |
$156.87
|
| Rate for Payer: Central Health Plan Commercial |
$278.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$244.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.44
|
| Rate for Payer: EPIC Health Plan Senior |
$139.44
|
| Rate for Payer: Galaxy Health WC |
$296.31
|
| Rate for Payer: Global Benefits Group Commercial |
$209.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$313.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$221.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$205.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.72
|
| Rate for Payer: Multiplan Commercial |
$261.45
|
| Rate for Payer: Networks By Design Commercial |
$226.59
|
| Rate for Payer: Prime Health Services Commercial |
$296.31
|
|
|
HC SHTH PER-Q 8.5FR X 10CM BRK
|
Facility
|
IP
|
$279.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Adventist Health Commercial |
$55.86
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Central Health Plan Commercial |
$223.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.72
|
| Rate for Payer: EPIC Health Plan Senior |
$111.72
|
| Rate for Payer: Galaxy Health WC |
$237.41
|
| Rate for Payer: Global Benefits Group Commercial |
$167.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$251.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.86
|
| Rate for Payer: Multiplan Commercial |
$209.47
|
| Rate for Payer: Networks By Design Commercial |
$181.54
|
| Rate for Payer: Prime Health Services Commercial |
$237.41
|
|
|
HC SHTH PER-Q 8.5FR X 10CM BRK
|
Facility
|
OP
|
$279.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901605343
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$251.37 |
| Rate for Payer: Adventist Health Commercial |
$55.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$237.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$153.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$209.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.47
|
| Rate for Payer: Blue Shield of California Commercial |
$177.08
|
| Rate for Payer: Blue Shield of California EPN |
$111.44
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Cash Price |
$125.68
|
| Rate for Payer: Central Health Plan Commercial |
$223.44
|
| Rate for Payer: Cigna of CA HMO |
$178.75
|
| Rate for Payer: Cigna of CA PPO |
$206.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$237.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$237.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$237.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$195.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$111.72
|
| Rate for Payer: EPIC Health Plan Senior |
$111.72
|
| Rate for Payer: Galaxy Health WC |
$237.41
|
| Rate for Payer: Global Benefits Group Commercial |
$167.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$251.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$177.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$101.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$164.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$195.51
|
| Rate for Payer: Multiplan Commercial |
$209.47
|
| Rate for Payer: Networks By Design Commercial |
$181.54
|
| Rate for Payer: Prime Health Services Commercial |
$237.41
|
| Rate for Payer: Riverside University Health System MISP |
$111.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$167.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$167.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.65
|
| Rate for Payer: United Healthcare All Other HMO |
$139.65
|
| Rate for Payer: United Healthcare HMO Rider |
$139.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$139.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$237.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$237.41
|
| Rate for Payer: Vantage Medical Group Senior |
$237.41
|
|
|
HC SHUNT EVALUATION
|
Facility
|
IP
|
$2,176.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$435.20 |
| Max. Negotiated Rate |
$1,958.40 |
| Rate for Payer: Adventist Health Commercial |
$435.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,740.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,523.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$870.40
|
| Rate for Payer: EPIC Health Plan Senior |
$870.40
|
| Rate for Payer: Galaxy Health WC |
$1,849.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,305.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,958.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,381.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,283.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.20
|
| Rate for Payer: Multiplan Commercial |
$1,632.00
|
| Rate for Payer: Networks By Design Commercial |
$1,414.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,849.60
|
|
|
HC SHUNT EVALUATION
|
Facility
|
OP
|
$2,176.00
|
|
|
Service Code
|
CPT 78645
|
| Hospital Charge Code |
909301415
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$256.90 |
| Max. Negotiated Rate |
$1,958.40 |
| Rate for Payer: Adventist Health Commercial |
$435.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,527.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$708.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,265.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,370.88
|
| Rate for Payer: Blue Shield of California EPN |
$863.87
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Cash Price |
$979.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,740.80
|
| Rate for Payer: Cigna of CA HMO |
$1,392.64
|
| Rate for Payer: Cigna of CA PPO |
$1,610.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,523.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$1,849.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,305.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,958.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,381.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$283.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$1,632.00
|
| Rate for Payer: Networks By Design Commercial |
$1,414.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,849.60
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,305.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,305.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC SHUNTOGRAM
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC SHUNTOGRAM
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 75809
|
| Hospital Charge Code |
909001355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$42.71 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$472.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$227.22
|
| Rate for Payer: Blue Shield of California Commercial |
$521.01
|
| Rate for Payer: Blue Shield of California EPN |
$328.32
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Cigna of CA HMO |
$529.28
|
| Rate for Payer: Cigna of CA PPO |
$611.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC SHVG LSN TRNK ARM LEG LT 0.5CM
|
Facility
|
IP
|
$438.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
902809295
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$87.60 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Adventist Health Commercial |
$87.60
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$175.20
|
| Rate for Payer: EPIC Health Plan Senior |
$175.20
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$258.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Networks By Design Commercial |
$284.70
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
|
|
HC SHVG LSN TRNK ARM LEG LT 0.5CM
|
Facility
|
OP
|
$438.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
902809295
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$50.22 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$179.58
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$163.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| Rate for Payer: Cigna of CA HMO |
$280.32
|
| Rate for Payer: Cigna of CA PPO |
$324.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$306.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$372.30
|
| Rate for Payer: Global Benefits Group Commercial |
$262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$394.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$278.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$328.50
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$284.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$372.30
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$262.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC SIALOGRAM
|
Facility
|
IP
|
$446.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.20 |
| Max. Negotiated Rate |
$401.40 |
| Rate for Payer: Adventist Health Commercial |
$89.20
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Central Health Plan Commercial |
$356.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$312.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.40
|
| Rate for Payer: EPIC Health Plan Senior |
$178.40
|
| Rate for Payer: Galaxy Health WC |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$401.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$283.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$263.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.20
|
| Rate for Payer: Multiplan Commercial |
$334.50
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
|
|
HC SIALOGRAM
|
Facility
|
OP
|
$446.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
909001167
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.09 |
| Max. Negotiated Rate |
$605.23 |
| Rate for Payer: Adventist Health Commercial |
$89.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$306.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$526.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$369.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$514.28
|
| Rate for Payer: Blue Shield of California Commercial |
$280.98
|
| Rate for Payer: Blue Shield of California EPN |
$177.06
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Central Health Plan Commercial |
$356.80
|
| Rate for Payer: Cigna of CA HMO |
$285.44
|
| Rate for Payer: Cigna of CA PPO |
$330.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$306.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$312.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.35
|
| Rate for Payer: EPIC Health Plan Senior |
$337.57
|
| Rate for Payer: Galaxy Health WC |
$379.10
|
| Rate for Payer: Global Benefits Group Commercial |
$267.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$401.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$503.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$283.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$429.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$411.22
|
| Rate for Payer: Multiplan Commercial |
$334.50
|
| Rate for Payer: Networks By Design Commercial |
$289.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$306.88
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
| Rate for Payer: Prime Health Services Medicare |
$325.29
|
| Rate for Payer: Riverside University Health System MISP |
$337.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$306.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.57
|
| Rate for Payer: Vantage Medical Group Senior |
$306.88
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
OP
|
$4,009.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$67.23 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$693.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$693.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,207.20
|
| Rate for Payer: Cigna of CA HMO |
$2,565.76
|
| Rate for Payer: Cigna of CA PPO |
$2,966.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$763.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$693.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,806.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.56
|
| Rate for Payer: EPIC Health Plan Senior |
$763.04
|
| Rate for Payer: Galaxy Health WC |
$3,407.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,405.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,608.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,137.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$693.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,545.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$74.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$971.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$929.52
|
| Rate for Payer: Multiplan Commercial |
$3,006.75
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$2,605.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$693.67
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$3,407.65
|
| Rate for Payer: Prime Health Services Medicare |
$735.29
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$763.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,405.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,004.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$693.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,040.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$763.04
|
| Rate for Payer: Vantage Medical Group Senior |
$693.67
|
|
|
HC SIALOGRAPHY DUCT DILATION
|
Facility
|
IP
|
$4,009.00
|
|
|
Service Code
|
CPT 42660
|
| Hospital Charge Code |
909000133
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$801.80 |
| Max. Negotiated Rate |
$3,608.10 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,207.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,806.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,603.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,603.60
|
| Rate for Payer: Galaxy Health WC |
$3,407.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,405.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,608.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,545.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,365.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.80
|
| Rate for Payer: Multiplan Commercial |
$3,006.75
|
| Rate for Payer: Networks By Design Commercial |
$2,605.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,407.65
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC SIALOGRAPHY INJECTION
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 42550
|
| Hospital Charge Code |
909000132
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$375.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
|
OP
|
$10,189.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.91 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,565.51
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: Cigna of CA HMO |
$6,520.96
|
| Rate for Payer: Cigna of CA PPO |
$7,539.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,470.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Preferred Health Network WC |
$6,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,520.08
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,690.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,094.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,094.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,094.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,094.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC SIALOLITHOTOMY, SUBMANDIBULAR
|
Facility
|
IP
|
$10,189.00
|
|
|
Service Code
|
CPT 42330
|
| Hospital Charge Code |
900501646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,037.80 |
| Max. Negotiated Rate |
$9,170.10 |
| Rate for Payer: Adventist Health Commercial |
$2,037.80
|
| Rate for Payer: Cash Price |
$4,585.05
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,075.60
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,470.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,011.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
|
|
HC S-ICD GEN&LEAD TEST POST IMPL
|
Facility
|
IP
|
$5,022.00
|
|
|
Service Code
|
CPT 93644
|
| Hospital Charge Code |
906811490
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,004.40 |
| Max. Negotiated Rate |
$4,519.80 |
| Rate for Payer: Adventist Health Commercial |
$1,004.40
|
| Rate for Payer: Cash Price |
$2,259.90
|
| Rate for Payer: Central Health Plan Commercial |
$4,017.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,515.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,008.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,008.80
|
| Rate for Payer: Galaxy Health WC |
$4,268.70
|
| Rate for Payer: Global Benefits Group Commercial |
$3,013.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,519.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,188.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,962.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,004.40
|
| Rate for Payer: Multiplan Commercial |
$3,766.50
|
| Rate for Payer: Networks By Design Commercial |
$3,264.30
|
| Rate for Payer: Prime Health Services Commercial |
$4,268.70
|
|
