|
HC SHOW OXFORD BRACE WOMAN
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT L3224
|
| Hospital Charge Code |
915353224
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Adventist Health Commercial |
$29.60
|
| Rate for Payer: Blue Shield of California Commercial |
$114.40
|
| Rate for Payer: Blue Shield of California EPN |
$74.59
|
| Rate for Payer: Cash Price |
$81.40
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$91.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| 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
|
|
|
HC SHTH CATH MANOSHIELD DISPOSABLE
|
Facility
|
IP
|
$183.75
|
|
| Hospital Charge Code |
900100347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$165.38 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: Central Health Plan Commercial |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$137.81
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
|
|
HC SHTH CATH MANOSHIELD DISPOSABLE
|
Facility
|
OP
|
$183.75
|
|
| Hospital Charge Code |
900100347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$165.38 |
| Rate for Payer: Adventist Health Commercial |
$36.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$88.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.92
|
| Rate for Payer: Blue Shield of California Commercial |
$112.27
|
| Rate for Payer: Blue Shield of California EPN |
$73.32
|
| Rate for Payer: Cash Price |
$101.06
|
| Rate for Payer: Central Health Plan Commercial |
$147.00
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$135.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$156.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$156.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$156.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.50
|
| Rate for Payer: EPIC Health Plan Senior |
$73.50
|
| Rate for Payer: Galaxy Health WC |
$156.19
|
| Rate for Payer: Global Benefits Group Commercial |
$110.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$165.38
|
| Rate for Payer: InnovAge PACE Commercial |
$91.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$128.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$128.62
|
| Rate for Payer: Multiplan Commercial |
$137.81
|
| Rate for Payer: Networks By Design Commercial |
$119.44
|
| Rate for Payer: Prime Health Services Commercial |
$156.19
|
| Rate for Payer: Riverside University Health System MISP |
$73.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.88
|
| Rate for Payer: United Healthcare All Other HMO |
$91.88
|
| Rate for Payer: United Healthcare HMO Rider |
$91.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$91.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$156.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$156.19
|
| Rate for Payer: Vantage Medical Group Senior |
$156.19
|
|
|
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 |
$209.16 |
| Rate for Payer: Adventist Health Commercial |
$46.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.14
|
| 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 |
$136.49
|
| Rate for Payer: Blue Shield of California Commercial |
$142.00
|
| Rate for Payer: Blue Shield of California EPN |
$92.73
|
| Rate for Payer: Cash Price |
$127.82
|
| 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: 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: InnovAge PACE Commercial |
$116.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.68
|
| Rate for Payer: Molina Healthcare of CA 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 |
$127.82
|
| Rate for Payer: Central Health Plan Commercial |
$185.92
|
| 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 Permanente of CA Commercial/Self Funded |
$155.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.86
|
| 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
|
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 |
$118.46
|
| Rate for Payer: Central Health Plan Commercial |
$172.31
|
| 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 Permanente of CA Commercial/Self Funded |
$143.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.33
|
| 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 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 |
$193.85 |
| Rate for Payer: Adventist Health Commercial |
$43.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.81
|
| 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 |
$126.50
|
| Rate for Payer: Blue Shield of California Commercial |
$131.60
|
| Rate for Payer: Blue Shield of California EPN |
$85.94
|
| Rate for Payer: Cash Price |
$118.46
|
| 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: 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: InnovAge PACE Commercial |
$107.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$143.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$150.77
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$211.70
|
| 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 |
$204.73
|
| Rate for Payer: Blue Shield of California Commercial |
$212.99
|
| Rate for Payer: Blue Shield of California EPN |
$139.09
|
| Rate for Payer: Cash Price |
$191.73
|
| 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: 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: InnovAge PACE Commercial |
$174.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$244.02
|
| Rate for Payer: Molina Healthcare of CA 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 |
$191.73
|
| Rate for Payer: Central Health Plan Commercial |
$278.88
|
| 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 Permanente of CA Commercial/Self Funded |
$232.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.78
|
| 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 |
$153.62
|
| Rate for Payer: Central Health Plan Commercial |
$223.44
|
| 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 Permanente of CA Commercial/Self Funded |
$186.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.89
|
| 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 |
$169.62
|
| 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 |
$164.03
|
| Rate for Payer: Blue Shield of California Commercial |
$170.65
|
| Rate for Payer: Blue Shield of California EPN |
$111.44
|
| Rate for Payer: Cash Price |
$153.62
|
| 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: 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: InnovAge PACE Commercial |
$139.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$186.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$172.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$195.51
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,196.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,740.80
|
| 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 Permanente of CA Commercial/Self Funded |
$1,451.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$829.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,346.94
|
| 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 |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,321.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$708.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,277.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,320.83
|
| Rate for Payer: Blue Shield of California EPN |
$863.87
|
| Rate for Payer: Cash Price |
$1,196.80
|
| Rate for Payer: Cash Price |
$1,196.80
|
| 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 |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| 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 |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,451.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| 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 |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$1,849.60
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| 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 |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
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 |
$454.85
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| 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 Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| 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 |
$33.17 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$502.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.17
|
| Rate for Payer: Blue Shield of California Commercial |
$501.99
|
| Rate for Payer: Blue Shield of California EPN |
$328.32
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| 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 |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| 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 |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$42.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| 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 |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| 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 |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
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 |
$1,833.00 |
| 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 |
$266.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.24
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cash Price |
$240.90
|
| 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 |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| 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 |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| 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 |
$507.64
|
| 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 |
$538.10
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
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 |
$240.90
|
| Rate for Payer: Central Health Plan Commercial |
$350.40
|
| 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 Permanente of CA Commercial/Self Funded |
$292.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$271.12
|
| 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 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 |
$245.30
|
| Rate for Payer: Central Health Plan Commercial |
$356.80
|
| 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 Permanente of CA Commercial/Self Funded |
$297.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$276.07
|
| 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 |
$307.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$369.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.08
|
| Rate for Payer: Blue Shield of California Commercial |
$270.72
|
| Rate for Payer: Blue Shield of California EPN |
$177.06
|
| Rate for Payer: Cash Price |
$245.30
|
| Rate for Payer: Cash Price |
$245.30
|
| 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 |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| 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 |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: InnovAge PACE Commercial |
$460.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$297.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$411.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| 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 |
$307.13
|
| Rate for Payer: Prime Health Services Commercial |
$379.10
|
| Rate for Payer: Prime Health Services Medicare |
$325.56
|
| Rate for Payer: Riverside University Health System MISP |
$337.84
|
| 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 |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
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 |
$2,204.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,207.20
|
| 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 Permanente of CA Commercial/Self Funded |
$2,674.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,527.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.57
|
| 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 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$647.05
|
| 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 |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,030.97
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cash Price |
$2,204.95
|
| Rate for Payer: Cash Price |
$2,204.95
|
| 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 |
$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 |
$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 |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$67.23
|
| 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 |
$2,674.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$867.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$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 |
$647.05
|
| 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 |
$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 |
$2,405.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$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 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 |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| 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 |
$215.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| Rate for Payer: Cash Price |
$244.75
|
| 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: 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: InnovAge PACE Commercial |
$222.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.50
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,932.00
|
| 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 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 |
$244.75
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| 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 Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| 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 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$6,565.51
|
| Rate for Payer: Cash Price |
$5,603.95
|
| Rate for Payer: Cash Price |
$5,603.95
|
| Rate for Payer: Cash Price |
$5,603.95
|
| Rate for Payer: Cash Price |
$5,603.95
|
| 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 |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| 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 |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: InnovAge PACE Commercial |
$6,180.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,796.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| 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 |
$4,120.64
|
| 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 |
$4,367.88
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC 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 |
$5,603.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$4,075.60
|
| Rate for Payer: Galaxy Health WC |
$8,660.65
|
| Rate for Payer: Global Benefits Group Commercial |
$6,113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,796.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,882.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,306.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,037.80
|
| Rate for Payer: Multiplan Commercial |
$7,641.75
|
| Rate for Payer: Networks By Design Commercial |
$6,622.85
|
| Rate for Payer: Prime Health Services Commercial |
$8,660.65
|
|
