|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$1,319.40 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,172.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: EPIC Health Plan Senior |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,319.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$907.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.20
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
OP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$137.94 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$601.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$890.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$607.16
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,172.80
|
| Rate for Payer: Cigna of CA HMO |
$938.24
|
| Rate for Payer: Cigna of CA PPO |
$1,084.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$571.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$381.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$514.44
|
| Rate for Payer: EPIC Health Plan Senior |
$381.07
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,319.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$624.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$381.07
|
| Rate for Payer: InnovAge PACE Commercial |
$571.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$381.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$510.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$510.63
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Multiplan WC |
$607.16
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$381.07
|
| Rate for Payer: Preferred Health Network WC |
$619.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
| Rate for Payer: Prime Health Services Medicare |
$403.93
|
| Rate for Payer: Prime Health Services WC |
$600.96
|
| Rate for Payer: Riverside University Health System MISP |
$419.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$879.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$879.60
|
| 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 |
$381.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$571.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.18
|
| Rate for Payer: Vantage Medical Group Senior |
$381.07
|
|
|
HC REPROGRAM OF PROGRAM CSF SHUNT
|
Facility
|
IP
|
$1,466.00
|
|
|
Service Code
|
CPT 62252
|
| Hospital Charge Code |
900501354
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$293.20 |
| Max. Negotiated Rate |
$1,319.40 |
| Rate for Payer: Adventist Health Commercial |
$293.20
|
| Rate for Payer: Cash Price |
$806.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,172.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$586.40
|
| Rate for Payer: EPIC Health Plan Senior |
$586.40
|
| Rate for Payer: Galaxy Health WC |
$1,246.10
|
| Rate for Payer: Global Benefits Group Commercial |
$879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,319.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$977.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$558.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$907.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.20
|
| Rate for Payer: Multiplan Commercial |
$1,099.50
|
| Rate for Payer: Networks By Design Commercial |
$952.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,246.10
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
IP
|
$1,543.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$308.60 |
| Max. Negotiated Rate |
$1,388.70 |
| Rate for Payer: Adventist Health Commercial |
$308.60
|
| Rate for Payer: Cash Price |
$848.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,234.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.20
|
| Rate for Payer: EPIC Health Plan Senior |
$617.20
|
| Rate for Payer: Galaxy Health WC |
$1,311.55
|
| Rate for Payer: Global Benefits Group Commercial |
$925.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,388.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$587.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$955.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.60
|
| Rate for Payer: Multiplan Commercial |
$1,157.25
|
| Rate for Payer: Networks By Design Commercial |
$1,002.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,311.55
|
|
|
HC REPR,PALATE LACERATION LT 2 CM
|
Facility
|
OP
|
$1,543.00
|
|
|
Service Code
|
CPT 42180
|
| Hospital Charge Code |
900501564
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$297.81 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$308.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Cash Price |
$848.65
|
| Rate for Payer: Cash Price |
$848.65
|
| Rate for Payer: Cash Price |
$848.65
|
| Rate for Payer: Cash Price |
$848.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,234.40
|
| Rate for Payer: Cigna of CA HMO |
$987.52
|
| Rate for Payer: Cigna of CA PPO |
$1,141.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$1,311.55
|
| Rate for Payer: Global Benefits Group Commercial |
$925.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,388.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: InnovAge PACE Commercial |
$970.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,029.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$1,157.25
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$1,002.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$647.05
|
| Rate for Payer: Preferred Health Network WC |
$1,052.01
|
| Rate for Payer: Prime Health Services Commercial |
$1,311.55
|
| Rate for Payer: Prime Health Services Medicare |
$685.87
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Riverside University Health System MISP |
$711.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$925.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$771.50
|
| Rate for Payer: United Healthcare All Other HMO |
$771.50
|
| Rate for Payer: United Healthcare HMO Rider |
$771.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$771.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
OP
|
$6,623.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$2,715.43
|
| 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 |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: Cigna of CA HMO |
$4,238.72
|
| Rate for Payer: Cigna of CA PPO |
$4,901.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,973.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,973.80
|
| 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 |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
IP
|
$6,623.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,324.60 |
| Max. Negotiated Rate |
$5,960.70 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,649.20
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,523.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,099.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
OP
|
$6,623.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$145.71 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| 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 |
$442.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$470.13
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: Cigna of CA HMO |
$4,238.72
|
| Rate for Payer: Cigna of CA PPO |
$4,901.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$442.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$324.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.33
|
| Rate for Payer: EPIC Health Plan Senior |
$295.06
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$483.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$295.06
|
| Rate for Payer: InnovAge PACE Commercial |
$442.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.38
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Multiplan WC |
$470.13
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$295.06
|
| Rate for Payer: Preferred Health Network WC |
$479.72
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
| Rate for Payer: Prime Health Services Medicare |
$312.76
|
| Rate for Payer: Prime Health Services WC |
$465.33
|
| Rate for Payer: Riverside University Health System MISP |
$324.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,311.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,311.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,311.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,311.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$295.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$442.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$324.57
|
| Rate for Payer: Vantage Medical Group Senior |
$295.06
|
|
|
HC REPR POST LINGUAL LAC LT 2.5CM
|
Facility
|
IP
|
$6,623.00
|
|
|
Service Code
|
CPT 41251
|
| Hospital Charge Code |
900501149
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,324.60 |
| Max. Negotiated Rate |
$5,960.70 |
| Rate for Payer: Adventist Health Commercial |
$1,324.60
|
| Rate for Payer: Cash Price |
$3,642.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,298.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,649.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,649.20
|
| Rate for Payer: Galaxy Health WC |
$5,629.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,417.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,523.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,099.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,324.60
|
| Rate for Payer: Multiplan Commercial |
$4,967.25
|
| Rate for Payer: Networks By Design Commercial |
$4,304.95
|
| Rate for Payer: Prime Health Services Commercial |
$5,629.55
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$411.20 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Adventist Health Commercial |
$411.20
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,644.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$822.40
|
| Rate for Payer: EPIC Health Plan Senior |
$822.40
|
| Rate for Payer: Galaxy Health WC |
$1,747.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,233.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,850.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,371.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$783.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,272.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.20
|
| Rate for Payer: Multiplan Commercial |
$1,542.00
|
| Rate for Payer: Networks By Design Commercial |
$1,336.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,747.60
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$411.20 |
| Max. Negotiated Rate |
$1,850.40 |
| Rate for Payer: Adventist Health Commercial |
$411.20
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,644.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$822.40
|
| Rate for Payer: EPIC Health Plan Senior |
$822.40
|
| Rate for Payer: Galaxy Health WC |
$1,747.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,233.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,850.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,371.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$783.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,272.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.20
|
| Rate for Payer: Multiplan Commercial |
$1,542.00
|
| Rate for Payer: Networks By Design Commercial |
$1,336.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,747.60
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$842.96
|
| 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 |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,644.80
|
| Rate for Payer: Cigna of CA HMO |
$1,315.84
|
| Rate for Payer: Cigna of CA PPO |
$1,521.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,747.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,233.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,850.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,371.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$1,542.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$1,336.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.02
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,747.60
|
| Rate for Payer: Prime Health Services Medicare |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,233.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,233.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC REPR SUB/ANT LINGL LAC LT 2.5C
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
900501148
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$6,333.00 |
| Rate for Payer: Adventist Health Commercial |
$411.20
|
| 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 |
$760.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Cash Price |
$1,130.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,644.80
|
| Rate for Payer: Cigna of CA HMO |
$1,315.84
|
| Rate for Payer: Cigna of CA PPO |
$1,521.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$760.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$557.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$684.48
|
| Rate for Payer: EPIC Health Plan Senior |
$507.02
|
| Rate for Payer: Galaxy Health WC |
$1,747.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,233.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,850.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$831.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.02
|
| Rate for Payer: InnovAge PACE Commercial |
$760.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,371.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$411.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.41
|
| Rate for Payer: Multiplan Commercial |
$1,542.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$1,336.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$507.02
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,747.60
|
| Rate for Payer: Prime Health Services Medicare |
$537.44
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$557.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,233.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,028.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,028.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,028.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,028.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$760.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$557.72
|
| Rate for Payer: Vantage Medical Group Senior |
$507.02
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
IP
|
$12,404.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$2,480.80 |
| Max. Negotiated Rate |
$11,163.60 |
| Rate for Payer: Adventist Health Commercial |
$2,480.80
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,923.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,961.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,961.60
|
| Rate for Payer: Galaxy Health WC |
$10,543.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,442.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,163.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,725.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,678.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,480.80
|
| Rate for Payer: Multiplan Commercial |
$9,303.00
|
| Rate for Payer: Networks By Design Commercial |
$8,062.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,543.40
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
IP
|
$12,404.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,480.80 |
| Max. Negotiated Rate |
$11,163.60 |
| Rate for Payer: Adventist Health Commercial |
$2,480.80
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,923.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,961.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,961.60
|
| Rate for Payer: Galaxy Health WC |
$10,543.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,442.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,163.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,725.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,678.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,480.80
|
| Rate for Payer: Multiplan Commercial |
$9,303.00
|
| Rate for Payer: Networks By Design Commercial |
$8,062.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,543.40
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
OP
|
$12,404.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,163.60 |
| Rate for Payer: Adventist Health Commercial |
$5,085.64
|
| 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 |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,923.20
|
| Rate for Payer: Cigna of CA HMO |
$7,938.56
|
| Rate for Payer: Cigna of CA PPO |
$9,178.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$10,543.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,442.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,163.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,480.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$9,303.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,062.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$10,543.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,442.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,442.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC REP TEND/MUSC FLEX,FOREARM
|
Facility
|
OP
|
$12,404.00
|
|
|
Service Code
|
CPT 25260
|
| Hospital Charge Code |
900501066
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,163.60 |
| Rate for Payer: Adventist Health Commercial |
$2,480.80
|
| 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 |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Cash Price |
$6,822.20
|
| Rate for Payer: Central Health Plan Commercial |
$9,923.20
|
| Rate for Payer: Cigna of CA HMO |
$7,938.56
|
| Rate for Payer: Cigna of CA PPO |
$9,178.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$10,543.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,442.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,163.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$710.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,480.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$9,303.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,062.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$10,543.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,442.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,202.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,202.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,202.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,202.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC RESEARCH CLINIC VISIT
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
|
|
HC RESEARCH CLINIC VISIT
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600210
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$260.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.79
|
| Rate for Payer: Blue Shield of California Commercial |
$212.02
|
| Rate for Payer: Blue Shield of California EPN |
$138.45
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$222.08
|
| Rate for Payer: Cigna of CA PPO |
$256.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$294.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$294.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.64
|
| Rate for Payer: InnovAge PACE Commercial |
$173.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$242.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$242.90
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| Rate for Payer: Riverside University Health System MISP |
$138.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$173.50
|
| Rate for Payer: United Healthcare All Other HMO |
$173.50
|
| Rate for Payer: United Healthcare HMO Rider |
$173.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$294.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$294.95
|
|
|
HC RESEARCH IV HEPARIN LOCK PLACEMENT/BLOOD DRAW ESTAB PORT
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
900100027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.40 |
| Max. Negotiated Rate |
$411.30 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Cash Price |
$251.35
|
| Rate for Payer: Central Health Plan Commercial |
$365.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.80
|
| Rate for Payer: EPIC Health Plan Senior |
$182.80
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$411.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$282.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.40
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
|
|
HC RESEARCH IV HEPARIN LOCK PLACEMENT/BLOOD DRAW ESTAB PORT
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
900100027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.35 |
| Max. Negotiated Rate |
$411.30 |
| Rate for Payer: Adventist Health Commercial |
$91.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$277.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.35
|
| Rate for Payer: Blue Shield of California Commercial |
$277.40
|
| Rate for Payer: Blue Shield of California EPN |
$181.43
|
| Rate for Payer: Cash Price |
$251.35
|
| Rate for Payer: Cash Price |
$251.35
|
| Rate for Payer: Central Health Plan Commercial |
$365.60
|
| Rate for Payer: Cigna of CA HMO |
$292.48
|
| Rate for Payer: Cigna of CA PPO |
$338.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$388.45
|
| Rate for Payer: Global Benefits Group Commercial |
$274.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$411.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$304.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$174.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$342.75
|
| Rate for Payer: Networks By Design Commercial |
$297.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$388.45
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$274.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$274.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.50
|
| Rate for Payer: United Healthcare All Other HMO |
$228.50
|
| Rate for Payer: United Healthcare HMO Rider |
$228.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$228.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC RESEARCH OBSERVATION 1-4 HOURS
|
Facility
|
OP
|
$466.00
|
|
| Hospital Charge Code |
900100025
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$2,789.00 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$283.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$396.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$256.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$349.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$284.73
|
| Rate for Payer: Blue Shield of California EPN |
$185.93
|
| Rate for Payer: Cash Price |
$256.30
|
| Rate for Payer: Cash Price |
$256.30
|
| Rate for Payer: Central Health Plan Commercial |
$372.80
|
| Rate for Payer: Cigna of CA HMO |
$298.24
|
| Rate for Payer: Cigna of CA PPO |
$344.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$396.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$396.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$396.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.40
|
| Rate for Payer: EPIC Health Plan Senior |
$186.40
|
| Rate for Payer: Galaxy Health WC |
$396.10
|
| Rate for Payer: Global Benefits Group Commercial |
$279.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$419.40
|
| Rate for Payer: InnovAge PACE Commercial |
$233.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$310.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$288.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$326.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$326.20
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
| Rate for Payer: Networks By Design Commercial |
$302.90
|
| Rate for Payer: Prime Health Services Commercial |
$396.10
|
| Rate for Payer: Riverside University Health System MISP |
$186.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$279.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$279.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$233.00
|
| Rate for Payer: United Healthcare HMO Rider |
$233.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$396.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$396.10
|
| Rate for Payer: Vantage Medical Group Senior |
$396.10
|
|
|
HC RESEARCH OBSERVATION 1-4 HOURS
|
Facility
|
IP
|
$466.00
|
|
| Hospital Charge Code |
900100025
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$93.20 |
| Max. Negotiated Rate |
$419.40 |
| Rate for Payer: Adventist Health Commercial |
$93.20
|
| Rate for Payer: Cash Price |
$256.30
|
| Rate for Payer: Central Health Plan Commercial |
$372.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$186.40
|
| Rate for Payer: EPIC Health Plan Senior |
$186.40
|
| Rate for Payer: Galaxy Health WC |
$396.10
|
| Rate for Payer: Global Benefits Group Commercial |
$279.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$419.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$310.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$177.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$288.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.20
|
| Rate for Payer: Multiplan Commercial |
$349.50
|
| Rate for Payer: Networks By Design Commercial |
$302.90
|
| Rate for Payer: Prime Health Services Commercial |
$396.10
|
|
|
HC RESEARCH OBSERVATION 4-8 HOURS
|
Facility
|
OP
|
$934.00
|
|
| Hospital Charge Code |
900100026
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$2,789.00 |
| Rate for Payer: Adventist Health Commercial |
$186.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$567.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$793.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$513.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$700.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$570.67
|
| Rate for Payer: Blue Shield of California EPN |
$372.67
|
| Rate for Payer: Cash Price |
$513.70
|
| Rate for Payer: Cash Price |
$513.70
|
| Rate for Payer: Central Health Plan Commercial |
$747.20
|
| Rate for Payer: Cigna of CA HMO |
$597.76
|
| Rate for Payer: Cigna of CA PPO |
$691.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$793.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$793.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$793.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.60
|
| Rate for Payer: EPIC Health Plan Senior |
$373.60
|
| Rate for Payer: Galaxy Health WC |
$793.90
|
| Rate for Payer: Global Benefits Group Commercial |
$560.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$840.60
|
| Rate for Payer: InnovAge PACE Commercial |
$467.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$622.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$578.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$653.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$653.80
|
| Rate for Payer: Multiplan Commercial |
$700.50
|
| Rate for Payer: Networks By Design Commercial |
$607.10
|
| Rate for Payer: Prime Health Services Commercial |
$793.90
|
| Rate for Payer: Riverside University Health System MISP |
$373.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$560.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$560.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.00
|
| Rate for Payer: United Healthcare All Other HMO |
$467.00
|
| Rate for Payer: United Healthcare HMO Rider |
$467.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$793.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$793.90
|
| Rate for Payer: Vantage Medical Group Senior |
$793.90
|
|
|
HC RESEARCH OBSERVATION 4-8 HOURS
|
Facility
|
IP
|
$934.00
|
|
| Hospital Charge Code |
900100026
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$840.60 |
| Rate for Payer: Adventist Health Commercial |
$186.80
|
| Rate for Payer: Cash Price |
$513.70
|
| Rate for Payer: Central Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.60
|
| Rate for Payer: EPIC Health Plan Senior |
$373.60
|
| Rate for Payer: Galaxy Health WC |
$793.90
|
| Rate for Payer: Global Benefits Group Commercial |
$560.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$840.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$622.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$578.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.80
|
| Rate for Payer: Multiplan Commercial |
$700.50
|
| Rate for Payer: Networks By Design Commercial |
$607.10
|
| Rate for Payer: Prime Health Services Commercial |
$793.90
|
|
