|
HC BK SHRINKER
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT L8440
|
| Hospital Charge Code |
915358440
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cigna of CA HMO |
$74.90
|
| Rate for Payer: Cigna of CA PPO |
$74.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.80
|
| Rate for Payer: EPIC Health Plan Senior |
$42.80
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$63.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.68
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.16
|
| Rate for Payer: United Healthcare All Other HMO |
$39.09
|
| Rate for Payer: United Healthcare HMO Rider |
$38.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.04
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$308.55 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$145.20
|
| Rate for Payer: Galaxy Health WC |
$308.55
|
| Rate for Payer: Global Benefits Group Commercial |
$217.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$230.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$214.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.12
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: Networks By Design Commercial |
$235.95
|
| Rate for Payer: Prime Health Services Commercial |
$308.55
|
|
|
HC BK VIRUS DNA DETECTION BY PCR
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913628
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$350.50 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$167.34
|
| Rate for Payer: Blue Shield of California Commercial |
$253.01
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cash Price |
$163.35
|
| Rate for Payer: Cigna of CA HMO |
$232.32
|
| Rate for Payer: Cigna of CA PPO |
$268.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$254.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$308.55
|
| Rate for Payer: Global Benefits Group Commercial |
$217.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$230.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: Networks By Design Commercial |
$235.95
|
| Rate for Payer: Prime Health Services Commercial |
$308.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC BK VIRUS DNA QUANT
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913625
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$356.23 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$356.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.05
|
| Rate for Payer: Blue Shield of California Commercial |
$153.05
|
| Rate for Payer: Blue Shield of California Commercial |
$126.31
|
| Rate for Payer: Blue Shield of California Commercial |
$231.40
|
| Rate for Payer: Blue Shield of California Commercial |
$190.98
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna of CA HMO |
$212.48
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Cigna of CA PPO |
$245.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC BLADDER INSTILL ANTICARCINOGEN
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
911800119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$167.63 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$189.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Cigna of CA HMO |
$604.80
|
| Rate for Payer: Cigna of CA PPO |
$699.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$661.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.79
|
| Rate for Payer: EPIC Health Plan Senior |
$986.52
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$600.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,130.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.77
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$567.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$472.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$896.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
HC BLADDER INSTILL ANTICARCINOGEN
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 51720
|
| Hospital Charge Code |
911800119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$803.25 |
| Rate for Payer: Adventist Health Commercial |
$189.00
|
| Rate for Payer: Cash Price |
$425.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$661.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$378.00
|
| Rate for Payer: EPIC Health Plan Senior |
$378.00
|
| Rate for Payer: Galaxy Health WC |
$803.25
|
| Rate for Payer: Global Benefits Group Commercial |
$567.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$600.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$557.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$226.80
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Networks By Design Commercial |
$614.25
|
| Rate for Payer: Prime Health Services Commercial |
$803.25
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$322.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cigna of CA HMO |
$503.68
|
| Rate for Payer: Cigna of CA PPO |
$582.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.20
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.40 |
| Max. Negotiated Rate |
$817.70 |
| Rate for Payer: Adventist Health Commercial |
$192.40
|
| Rate for Payer: Cash Price |
$432.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$673.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$384.80
|
| Rate for Payer: EPIC Health Plan Senior |
$384.80
|
| Rate for Payer: Galaxy Health WC |
$817.70
|
| Rate for Payer: Global Benefits Group Commercial |
$577.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$610.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$567.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.88
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: Networks By Design Commercial |
$625.30
|
| Rate for Payer: Prime Health Services Commercial |
$817.70
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$131.98 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$328.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Cigna of CA HMO |
$503.68
|
| Rate for Payer: Cigna of CA PPO |
$582.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.50
|
| Rate for Payer: United Healthcare All Other HMO |
$393.50
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
906551700
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.98 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$192.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$432.90
|
| Rate for Payer: Cash Price |
$432.90
|
| Rate for Payer: Cash Price |
$432.90
|
| Rate for Payer: Cigna of CA HMO |
$615.68
|
| Rate for Payer: Cigna of CA PPO |
$711.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$673.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$817.70
|
| Rate for Payer: Global Benefits Group Commercial |
$577.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$131.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$610.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$449.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$625.30
|
| Rate for Payer: Prime Health Services Commercial |
$817.70
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.00
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$668.95 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.88
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
|
|
HC BLADDER IRRIGATION/LAVAGE
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 51700
|
| Hospital Charge Code |
907251700
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$668.95 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Cash Price |
$354.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$550.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$499.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$464.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.88
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Adventist Health Commercial |
$3.20
|
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.56
|
| Rate for Payer: Blue Shield of California Commercial |
$154.44
|
| Rate for Payer: Blue Shield of California Commercial |
$11.15
|
| Rate for Payer: Blue Shield of California Commercial |
$233.50
|
| Rate for Payer: Blue Shield of California Commercial |
$7.38
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna of CA HMO |
$214.40
|
| Rate for Payer: Cigna of CA HMO |
$10.24
|
| Rate for Payer: Cigna of CA PPO |
$11.84
|
| Rate for Payer: Cigna of CA PPO |
$247.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$234.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.95
|
| Rate for Payer: EPIC Health Plan Senior |
$5.30
|
| Rate for Payer: EPIC Health Plan Senior |
$5.30
|
| Rate for Payer: Galaxy Health WC |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.60
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Networks By Design Commercial |
$10.40
|
| Rate for Payer: Prime Health Services Commercial |
$13.60
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$201.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$201.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.91
|
| Rate for Payer: United Healthcare All Other HMO |
$3.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3.91
|
| Rate for Payer: United Healthcare HMO Rider |
$3.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
| Rate for Payer: Vantage Medical Group Senior |
$4.82
|
|
|
HC BLEEDING TIME TEMPLATE
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 85002
|
| Hospital Charge Code |
900910065
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$67.00 |
| Max. Negotiated Rate |
$284.75 |
| Rate for Payer: Adventist Health Commercial |
$67.00
|
| Rate for Payer: Cash Price |
$150.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$234.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.00
|
| Rate for Payer: EPIC Health Plan Senior |
$134.00
|
| Rate for Payer: Galaxy Health WC |
$284.75
|
| Rate for Payer: Global Benefits Group Commercial |
$201.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$212.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$197.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.40
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: Networks By Design Commercial |
$217.75
|
| Rate for Payer: Prime Health Services Commercial |
$284.75
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$236.97 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Adventist Health Commercial |
$456.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$699.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna of CA HMO |
$712.96
|
| Rate for Payer: Cigna of CA PPO |
$824.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$779.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$946.90
|
| Rate for Payer: Global Benefits Group Commercial |
$668.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$707.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$891.20
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$724.10
|
| Rate for Payer: Prime Health Services Commercial |
$946.90
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$668.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$668.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
OP
|
$1,114.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.80 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$222.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$408.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna of CA HMO |
$712.96
|
| Rate for Payer: Cigna of CA PPO |
$824.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$612.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$449.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$408.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$779.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$449.06
|
| Rate for Payer: Galaxy Health WC |
$946.90
|
| Rate for Payer: Global Benefits Group Commercial |
$668.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$669.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$408.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$707.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$236.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$438.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$514.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$547.04
|
| Rate for Payer: Multiplan Commercial |
$891.20
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$724.10
|
| Rate for Payer: Prime Health Services Commercial |
$946.90
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$668.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$557.00
|
| Rate for Payer: United Healthcare All Other HMO |
$557.00
|
| Rate for Payer: United Healthcare HMO Rider |
$557.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$557.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$408.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$612.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$449.06
|
| Rate for Payer: Vantage Medical Group Senior |
$408.24
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$222.80 |
| Max. Negotiated Rate |
$946.90 |
| Rate for Payer: Adventist Health Commercial |
$222.80
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$779.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.60
|
| Rate for Payer: EPIC Health Plan Senior |
$445.60
|
| Rate for Payer: Galaxy Health WC |
$946.90
|
| Rate for Payer: Global Benefits Group Commercial |
$668.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$707.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$657.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.36
|
| Rate for Payer: Multiplan Commercial |
$891.20
|
| Rate for Payer: Networks By Design Commercial |
$724.10
|
| Rate for Payer: Prime Health Services Commercial |
$946.90
|
|
|
HC BLEPHAROTOMY DRAIN ABSCESS EYE
|
Facility
|
IP
|
$1,114.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
900501547
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$222.80 |
| Max. Negotiated Rate |
$946.90 |
| Rate for Payer: Adventist Health Commercial |
$222.80
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$779.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.60
|
| Rate for Payer: EPIC Health Plan Senior |
$445.60
|
| Rate for Payer: Galaxy Health WC |
$946.90
|
| Rate for Payer: Global Benefits Group Commercial |
$668.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$707.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$657.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.36
|
| Rate for Payer: Multiplan Commercial |
$891.20
|
| Rate for Payer: Networks By Design Commercial |
$724.10
|
| Rate for Payer: Prime Health Services Commercial |
$946.90
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
OP
|
$8,335.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,000.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,584.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,251.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,508.41
|
| Rate for Payer: Blue Shield of California Commercial |
$3,638.65
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Cigna of CA HMO |
$5,334.40
|
| Rate for Payer: Cigna of CA PPO |
$6,167.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,084.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,084.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,834.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,334.00
|
| Rate for Payer: Galaxy Health WC |
$7,084.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,001.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,118.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,292.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,264.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,917.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,834.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,834.50
|
| Rate for Payer: Multiplan Commercial |
$6,668.00
|
| Rate for Payer: Networks By Design Commercial |
$5,417.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,084.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,001.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,167.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,084.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,084.75
|
| Rate for Payer: Vantage Medical Group Senior |
$7,084.75
|
|
|
HC BLLN ANGIO CNTRL DIALYSIS SEG
|
Facility
|
IP
|
$8,335.00
|
|
|
Service Code
|
CPT 36907
|
| Hospital Charge Code |
909036907
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,667.00 |
| Max. Negotiated Rate |
$7,084.75 |
| Rate for Payer: Adventist Health Commercial |
$1,667.00
|
| Rate for Payer: Cash Price |
$3,750.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,834.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,334.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,334.00
|
| Rate for Payer: Galaxy Health WC |
$7,084.75
|
| Rate for Payer: Global Benefits Group Commercial |
$5,001.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,292.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,917.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,000.40
|
| Rate for Payer: Multiplan Commercial |
$6,668.00
|
| Rate for Payer: Networks By Design Commercial |
$5,417.75
|
| Rate for Payer: Prime Health Services Commercial |
$7,084.75
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
IP
|
$14,969.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906812072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,993.80 |
| Max. Negotiated Rate |
$12,723.65 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,831.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
|
|
HC BLLN ANGIOPLASTY, PULM, ADD'L
|
Facility
|
OP
|
$14,969.00
|
|
|
Service Code
|
CPT 92998
|
| Hospital Charge Code |
906812072
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$476.63 |
| Max. Negotiated Rate |
$12,723.65 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,190.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,232.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,226.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cigna of CA HMO |
$9,580.16
|
| Rate for Payer: Cigna of CA PPO |
$11,077.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,723.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,723.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$476.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,831.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,478.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,478.30
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,981.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,981.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,723.65
|
| Rate for Payer: Vantage Medical Group Senior |
$12,723.65
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
IP
|
$14,969.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906812071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$2,993.80 |
| Max. Negotiated Rate |
$12,723.65 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,987.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,987.60
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,831.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
|
|
HC BLLN ANGIOPLASTY, PULM, INIT
|
Facility
|
OP
|
$14,969.00
|
|
|
Service Code
|
CPT 92997
|
| Hospital Charge Code |
906812071
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$676.00 |
| Max. Negotiated Rate |
$24,498.80 |
| Rate for Payer: Adventist Health Commercial |
$2,993.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,351.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cash Price |
$6,736.05
|
| Rate for Payer: Cigna of CA HMO |
$9,580.16
|
| Rate for Payer: Cigna of CA PPO |
$11,077.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,478.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$12,723.65
|
| Rate for Payer: Global Benefits Group Commercial |
$8,981.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$915.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,505.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,035.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,592.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$11,975.20
|
| Rate for Payer: Networks By Design Commercial |
$9,729.85
|
| Rate for Payer: Prime Health Services Commercial |
$12,723.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,981.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,981.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
