|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
|
OP
|
$6,725.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$3,026.25
|
| Rate for Payer: Cash Price |
$3,026.25
|
| Rate for Payer: Cash Price |
$3,026.25
|
| Rate for Payer: Cigna of CA HMO |
$4,304.00
|
| Rate for Payer: Cigna of CA PPO |
$4,976.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$127.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$5,380.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$4,371.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,035.00
|
| 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: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
|
IP
|
$6,725.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,345.00 |
| Max. Negotiated Rate |
$5,716.25 |
| Rate for Payer: Adventist Health Commercial |
$1,345.00
|
| Rate for Payer: Cash Price |
$3,026.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,690.00
|
| Rate for Payer: Galaxy Health WC |
$5,716.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,485.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,562.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,162.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,614.00
|
| Rate for Payer: Multiplan Commercial |
$5,380.00
|
| Rate for Payer: Networks By Design Commercial |
$4,371.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,716.25
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$237.67 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$305.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$686.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna of CA HMO |
$976.64
|
| Rate for Payer: Cigna of CA PPO |
$1,129.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,297.10
|
| Rate for Payer: Global Benefits Group Commercial |
$915.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$237.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,220.80
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$991.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.10
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$915.60
|
| 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: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$305.20 |
| Max. Negotiated Rate |
$1,297.10 |
| Rate for Payer: Adventist Health Commercial |
$305.20
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$610.40
|
| Rate for Payer: EPIC Health Plan Senior |
$610.40
|
| Rate for Payer: Galaxy Health WC |
$1,297.10
|
| Rate for Payer: Global Benefits Group Commercial |
$915.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,017.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$581.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$944.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$366.24
|
| Rate for Payer: Multiplan Commercial |
$1,220.80
|
| Rate for Payer: Networks By Design Commercial |
$991.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,297.10
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
IP
|
$980.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$833.00 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$373.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$606.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Multiplan Commercial |
$784.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
OP
|
$980.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$196.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$833.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$539.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$735.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cash Price |
$441.00
|
| Rate for Payer: Cigna of CA HMO |
$627.20
|
| Rate for Payer: Cigna of CA PPO |
$725.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$833.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$833.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$833.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$392.00
|
| Rate for Payer: EPIC Health Plan Senior |
$392.00
|
| Rate for Payer: Galaxy Health WC |
$833.00
|
| Rate for Payer: Global Benefits Group Commercial |
$588.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$135.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$653.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$606.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$235.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$686.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$686.00
|
| Rate for Payer: Multiplan Commercial |
$784.00
|
| Rate for Payer: Networks By Design Commercial |
$637.00
|
| Rate for Payer: Prime Health Services Commercial |
$833.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$588.00
|
| 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 |
$833.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$833.00
|
| Rate for Payer: Vantage Medical Group Senior |
$833.00
|
|
|
HC CESAREAN DELIVERY ONLY
|
Facility
|
OP
|
$3,725.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
900501514
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$11,413.00 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,443.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,166.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,048.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,793.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,413.00
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: Cigna of CA HMO |
$2,384.00
|
| Rate for Payer: Cigna of CA PPO |
$2,756.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,166.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,166.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,166.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,490.00
|
| Rate for Payer: Galaxy Health WC |
$3,166.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$915.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,484.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,034.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,305.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,607.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,607.50
|
| Rate for Payer: Multiplan Commercial |
$2,980.00
|
| Rate for Payer: Networks By Design Commercial |
$2,421.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,166.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,235.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,235.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,166.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,166.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,166.25
|
|
|
HC CESAREAN DELIVERY ONLY
|
Facility
|
IP
|
$3,725.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
900501514
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$745.00 |
| Max. Negotiated Rate |
$3,166.25 |
| Rate for Payer: Adventist Health Commercial |
$745.00
|
| Rate for Payer: Cash Price |
$1,676.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,490.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,490.00
|
| Rate for Payer: Galaxy Health WC |
$3,166.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,235.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,484.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,419.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,305.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$894.00
|
| Rate for Payer: Multiplan Commercial |
$2,980.00
|
| Rate for Payer: Networks By Design Commercial |
$2,421.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,166.25
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
OP
|
$6,349.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.69 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,269.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,857.05
|
| Rate for Payer: Cash Price |
$2,857.05
|
| Rate for Payer: Cash Price |
$2,857.05
|
| Rate for Payer: Cigna of CA HMO |
$4,063.36
|
| Rate for Payer: Cigna of CA PPO |
$4,698.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$5,396.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,809.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$758.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,079.20
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,126.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,396.65
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,809.40
|
| 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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
IP
|
$6,349.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,269.80 |
| Max. Negotiated Rate |
$5,396.65 |
| Rate for Payer: Adventist Health Commercial |
$1,269.80
|
| Rate for Payer: Cash Price |
$2,857.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,539.60
|
| Rate for Payer: Galaxy Health WC |
$5,396.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,809.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,234.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,418.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,930.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.76
|
| Rate for Payer: Multiplan Commercial |
$5,079.20
|
| Rate for Payer: Networks By Design Commercial |
$4,126.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,396.65
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
IP
|
$4,486.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$3,813.10 |
| Rate for Payer: Adventist Health Commercial |
$897.20
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.40
|
| Rate for Payer: Galaxy Health WC |
$3,813.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,776.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.64
|
| Rate for Payer: Multiplan Commercial |
$3,588.80
|
| Rate for Payer: Networks By Design Commercial |
$2,915.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
OP
|
$4,486.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$897.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cigna of CA HMO |
$2,871.04
|
| Rate for Payer: Cigna of CA PPO |
$3,319.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$3,813.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,533.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$3,588.80
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$2,915.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,691.60
|
| 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 |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC CHANGE OF CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
OP
|
$1,814.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
909000710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$176.38 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$362.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$816.30
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: Cigna of CA HMO |
$1,160.96
|
| Rate for Payer: Cigna of CA PPO |
$1,342.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$1,541.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,088.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,209.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$1,451.20
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,179.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,541.90
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,088.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC CHANGE OF CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
IP
|
$1,814.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
909000710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$362.80 |
| Max. Negotiated Rate |
$1,541.90 |
| Rate for Payer: Adventist Health Commercial |
$362.80
|
| Rate for Payer: Cash Price |
$816.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$725.60
|
| Rate for Payer: EPIC Health Plan Senior |
$725.60
|
| Rate for Payer: Galaxy Health WC |
$1,541.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,088.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,209.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,122.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.36
|
| Rate for Payer: Multiplan Commercial |
$1,451.20
|
| Rate for Payer: Networks By Design Commercial |
$1,179.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,541.90
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
IP
|
$5,569.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,113.80 |
| Max. Negotiated Rate |
$4,733.65 |
| Rate for Payer: Adventist Health Commercial |
$1,113.80
|
| Rate for Payer: Cash Price |
$2,506.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,227.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.60
|
| Rate for Payer: Galaxy Health WC |
$4,733.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,341.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,714.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,121.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,447.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.56
|
| Rate for Payer: Multiplan Commercial |
$4,455.20
|
| Rate for Payer: Networks By Design Commercial |
$3,619.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,733.65
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
OP
|
$5,569.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.59 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,113.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,506.05
|
| Rate for Payer: Cash Price |
$2,506.05
|
| Rate for Payer: Cash Price |
$2,506.05
|
| Rate for Payer: Cigna of CA HMO |
$3,564.16
|
| Rate for Payer: Cigna of CA PPO |
$4,121.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$4,733.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,341.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,714.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$4,455.20
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$3,619.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,733.65
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,341.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,784.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,784.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,784.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,784.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
|
OP
|
$9,551.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,910.20 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,910.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| 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 |
$2,470.08
|
| Rate for Payer: Cash Price |
$4,297.95
|
| Rate for Payer: Cash Price |
$4,297.95
|
| Rate for Payer: Cash Price |
$4,297.95
|
| Rate for Payer: Cigna of CA HMO |
$6,112.64
|
| Rate for Payer: Cigna of CA PPO |
$7,067.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$8,118.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,730.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,289.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,370.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,589.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,292.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$7,640.80
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$6,208.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,118.35
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,730.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
|
IP
|
$9,551.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,910.20 |
| Max. Negotiated Rate |
$8,118.35 |
| Rate for Payer: Adventist Health Commercial |
$1,910.20
|
| Rate for Payer: Cash Price |
$4,297.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,820.40
|
| Rate for Payer: Galaxy Health WC |
$8,118.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,730.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,370.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,638.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,912.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,292.24
|
| Rate for Payer: Multiplan Commercial |
$7,640.80
|
| Rate for Payer: Networks By Design Commercial |
$6,208.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,118.35
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$250.75 |
| Rate for Payer: Adventist Health Commercial |
$59.00
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: EPIC Health Plan Senior |
$118.00
|
| Rate for Payer: Galaxy Health WC |
$250.75
|
| Rate for Payer: Global Benefits Group Commercial |
$177.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$236.00
|
| Rate for Payer: Networks By Design Commercial |
$191.75
|
| Rate for Payer: Prime Health Services Commercial |
$250.75
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$120.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$250.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$221.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cigna of CA HMO |
$188.80
|
| Rate for Payer: Cigna of CA PPO |
$218.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: EPIC Health Plan Senior |
$118.00
|
| Rate for Payer: Galaxy Health WC |
$250.75
|
| Rate for Payer: Global Benefits Group Commercial |
$177.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.50
|
| Rate for Payer: Multiplan Commercial |
$236.00
|
| Rate for Payer: Networks By Design Commercial |
$191.75
|
| Rate for Payer: Prime Health Services Commercial |
$250.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$250.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.75
|
| Rate for Payer: Vantage Medical Group Senior |
$250.75
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$295.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$250.75 |
| Rate for Payer: Adventist Health Commercial |
$59.00
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: EPIC Health Plan Senior |
$118.00
|
| Rate for Payer: Galaxy Health WC |
$250.75
|
| Rate for Payer: Global Benefits Group Commercial |
$177.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$236.00
|
| Rate for Payer: Networks By Design Commercial |
$191.75
|
| Rate for Payer: Prime Health Services Commercial |
$250.75
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$120.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$193.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$250.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$221.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cigna of CA HMO |
$188.80
|
| Rate for Payer: Cigna of CA PPO |
$218.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$250.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$250.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$250.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: EPIC Health Plan Senior |
$118.00
|
| Rate for Payer: Galaxy Health WC |
$250.75
|
| Rate for Payer: Global Benefits Group Commercial |
$177.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$196.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$182.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$206.50
|
| Rate for Payer: Multiplan Commercial |
$236.00
|
| Rate for Payer: Networks By Design Commercial |
$191.75
|
| Rate for Payer: Prime Health Services Commercial |
$250.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$250.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$250.75
|
| Rate for Payer: Vantage Medical Group Senior |
$250.75
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$250.60 |
| Max. Negotiated Rate |
$1,065.05 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.20
|
| Rate for Payer: EPIC Health Plan Senior |
$501.20
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Multiplan Commercial |
$1,002.40
|
| Rate for Payer: Networks By Design Commercial |
$814.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$250.60 |
| Max. Negotiated Rate |
$1,065.05 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.20
|
| Rate for Payer: EPIC Health Plan Senior |
$501.20
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$775.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Multiplan Commercial |
$1,002.40
|
| Rate for Payer: Networks By Design Commercial |
$814.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Cigna of CA HMO |
$801.92
|
| Rate for Payer: Cigna of CA PPO |
$927.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,065.05
|
| Rate for Payer: Global Benefits Group Commercial |
$751.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$835.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,002.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$814.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$751.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$626.50
|
| Rate for Payer: United Healthcare All Other HMO |
$626.50
|
| Rate for Payer: United Healthcare HMO Rider |
$626.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$626.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
