|
HC ABD PARACENTESIS W IMAGE GUID
|
Facility
|
OP
|
$1,407.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
906749080
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$281.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$281.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$633.15
|
| Rate for Payer: Cash Price |
$633.15
|
| Rate for Payer: Cash Price |
$633.15
|
| Rate for Payer: Cigna of CA HMO |
$900.48
|
| Rate for Payer: Cigna of CA PPO |
$1,041.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,195.95
|
| Rate for Payer: Global Benefits Group Commercial |
$844.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$465.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$938.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$526.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$337.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,125.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$914.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,195.95
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$844.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ABD PARACENTESIS WO IMAGE GUID
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
906749081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
|
|
HC ABD PARACENTESIS WO IMAGE GUID
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901200098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
|
|
HC ABD PARACENTESIS WO IMAGE GUID
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901200098
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cigna of CA HMO |
$931.20
|
| Rate for Payer: Cigna of CA PPO |
$1,076.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ABD PARACENTESIS WO IMAGE GUID
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
906749081
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cigna of CA HMO |
$931.20
|
| Rate for Payer: Cigna of CA PPO |
$1,076.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cigna of CA HMO |
$931.20
|
| Rate for Payer: Cigna of CA PPO |
$1,076.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
|
IP
|
$1,455.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$291.00 |
| Max. Negotiated Rate |
$1,236.75 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$582.00
|
| Rate for Payer: EPIC Health Plan Senior |
$582.00
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$554.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$900.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
|
|
HC ABD PARACENTESIS WO IMAGE GUIDE
|
Facility
|
OP
|
$1,455.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
901249082
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$98.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$291.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cash Price |
$654.75
|
| Rate for Payer: Cigna of CA HMO |
$931.20
|
| Rate for Payer: Cigna of CA PPO |
$1,076.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,236.75
|
| Rate for Payer: Global Benefits Group Commercial |
$873.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$970.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,164.00
|
| Rate for Payer: Networks By Design Commercial |
$945.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,236.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$873.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
IP
|
$1,913.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.60 |
| Max. Negotiated Rate |
$1,626.05 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$765.20
|
| Rate for Payer: EPIC Health Plan Senior |
$765.20
|
| Rate for Payer: Galaxy Health WC |
$1,626.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,147.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,275.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$728.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,184.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.12
|
| Rate for Payer: Multiplan Commercial |
$1,530.40
|
| Rate for Payer: Networks By Design Commercial |
$1,243.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,626.05
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
OP
|
$2,589.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
906820173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.87 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$517.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,200.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,423.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,941.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: Cigna of CA HMO |
$1,656.96
|
| Rate for Payer: Cigna of CA PPO |
$1,915.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,200.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,200.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,200.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,035.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,035.60
|
| Rate for Payer: Galaxy Health WC |
$2,200.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,553.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$340.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,726.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,602.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,812.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,812.30
|
| Rate for Payer: Multiplan Commercial |
$2,071.20
|
| Rate for Payer: Networks By Design Commercial |
$1,682.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,200.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,553.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$2,200.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,200.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,200.65
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
IP
|
$2,589.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
906820173
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$517.80 |
| Max. Negotiated Rate |
$2,200.65 |
| Rate for Payer: Adventist Health Commercial |
$517.80
|
| Rate for Payer: Cash Price |
$1,165.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,035.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,035.60
|
| Rate for Payer: Galaxy Health WC |
$2,200.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,553.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,726.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,602.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$621.36
|
| Rate for Payer: Multiplan Commercial |
$2,071.20
|
| Rate for Payer: Networks By Design Commercial |
$1,682.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,200.65
|
|
|
HC ABD/PEL/LE ART, 1ST ORDR CA
|
Facility
|
OP
|
$1,913.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
909081315
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$340.87 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$382.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,626.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,052.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,434.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cash Price |
$860.85
|
| Rate for Payer: Cigna of CA HMO |
$1,224.32
|
| Rate for Payer: Cigna of CA PPO |
$1,415.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,626.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,626.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,626.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$765.20
|
| Rate for Payer: EPIC Health Plan Senior |
$765.20
|
| Rate for Payer: Galaxy Health WC |
$1,626.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,147.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$340.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,275.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,184.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,339.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,339.10
|
| Rate for Payer: Multiplan Commercial |
$1,530.40
|
| Rate for Payer: Networks By Design Commercial |
$1,243.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,626.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,147.80
|
| 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 |
$1,626.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,626.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,626.05
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO |
$437.76
|
| Rate for Payer: Cigna of CA PPO |
$506.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
906820180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$787.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$509.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$694.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cigna of CA HMO |
$592.64
|
| Rate for Payer: Cigna of CA PPO |
$685.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$787.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$787.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$787.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$370.40
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$409.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$573.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$648.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$648.20
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.60
|
| 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 |
$787.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$787.10
|
| Rate for Payer: Vantage Medical Group Senior |
$787.10
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
906820180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$787.10 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$370.40
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$573.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.24
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$926.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$787.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$509.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$694.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cigna of CA HMO |
$592.64
|
| Rate for Payer: Cigna of CA PPO |
$685.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$787.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$787.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$787.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$370.40
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$486.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$573.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$648.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$648.20
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.60
|
| 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 |
$787.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$787.10
|
| Rate for Payer: Vantage Medical Group Senior |
$787.10
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$260.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$926.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$787.10 |
| Rate for Payer: Adventist Health Commercial |
$185.20
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.40
|
| Rate for Payer: EPIC Health Plan Senior |
$370.40
|
| Rate for Payer: Galaxy Health WC |
$787.10
|
| Rate for Payer: Global Benefits Group Commercial |
$555.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$617.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$573.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.24
|
| Rate for Payer: Multiplan Commercial |
$740.80
|
| Rate for Payer: Networks By Design Commercial |
$601.90
|
| Rate for Payer: Prime Health Services Commercial |
$787.10
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$136.80 |
| Max. Negotiated Rate |
$7,885.00 |
| Rate for Payer: Adventist Health Commercial |
$136.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$376.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cash Price |
$307.80
|
| Rate for Payer: Cigna of CA HMO |
$437.76
|
| Rate for Payer: Cigna of CA PPO |
$506.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$581.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$581.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$581.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.60
|
| Rate for Payer: EPIC Health Plan Senior |
$273.60
|
| Rate for Payer: Galaxy Health WC |
$581.40
|
| Rate for Payer: Global Benefits Group Commercial |
$410.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$486.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$456.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$478.80
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Networks By Design Commercial |
$444.60
|
| Rate for Payer: Prime Health Services Commercial |
$581.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$410.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$581.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$581.40
|
| Rate for Payer: Vantage Medical Group Senior |
$581.40
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$480.25 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$349.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$291.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$473.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.57 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$113.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cigna of CA HMO |
$361.60
|
| Rate for Payer: Cigna of CA PPO |
$418.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$480.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$480.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$480.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Senior |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$349.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$395.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$395.50
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| 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 |
$480.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$480.25
|
| Rate for Payer: Vantage Medical Group Senior |
$480.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.57 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$650.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$420.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$573.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cigna of CA HMO |
$489.60
|
| Rate for Payer: Cigna of CA PPO |
$566.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$650.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$650.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$650.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$77.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$510.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$473.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.00
|
| 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 |
$650.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$650.25
|
| Rate for Payer: Vantage Medical Group Senior |
$650.25
|
|
