|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,269.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| 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 |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,444.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| 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/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$758.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,031.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$858.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,523.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| 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 |
$3,174.50
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$897.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| 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 |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| 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/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,533.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,848.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,733.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,076.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,109.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,307.17
|
| 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 |
$2,243.00
|
| 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 |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,848.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,646.74
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$362.80
|
| 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 |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| 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 |
$1,345.26
|
| 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 |
$1,269.80
|
| 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 |
$1,541.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,088.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,151.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$435.36
|
| 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 |
$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 |
$907.00
|
| 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 |
$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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,269.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,151.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,070.26
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,898.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,536.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,285.71
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,113.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,898.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| 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/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,536.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,910.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| 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 |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,685.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| 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/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,289.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,064.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,589.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,292.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| 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 |
$4,775.50
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
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: Galaxy Health WC |
$8,118.35
|
| Rate for Payer: Adventist Health Commercial |
$1,910.20
|
| Rate for Payer: Cash Price |
$4,297.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,685.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,820.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,820.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,730.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,064.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,635.09
|
| 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
|
OP
|
$295.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.80 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$120.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$335.30
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$187.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.05
|
| 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 |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$59.00 |
| Max. Negotiated Rate |
$250.75 |
| Rate for Payer: EPIC Health Plan Senior |
$118.00
|
| Rate for Payer: Galaxy Health WC |
$250.75
|
| Rate for Payer: Adventist Health Commercial |
$59.00
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.00
|
| Rate for Payer: Global Benefits Group Commercial |
$177.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.05
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$187.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.05
|
| 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 |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$120.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$335.30
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: Cash Price |
$132.75
|
| Rate for Payer: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$206.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$187.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.05
|
| 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
|
450
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$795.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$739.27
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| 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/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$795.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$33.77 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| 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 |
$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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| 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/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$795.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$751.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$626.50
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$795.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$739.27
|
| 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
|
456
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$513.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| 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/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$795.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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: TriValley Medical Group Commercial/Senior |
$751.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.77 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| 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/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$33.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$795.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$751.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,253.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$250.60 |
| Max. Negotiated Rate |
$1,065.05 |
| Rate for Payer: Networks By Design Commercial |
$814.45
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.05
|
| Rate for Payer: Adventist Health Commercial |
$250.60
|
| Rate for Payer: Cash Price |
$563.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$795.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$739.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.72
|
| Rate for Payer: Multiplan Commercial |
$1,002.40
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$877.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$795.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$739.27
|
| 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 CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$615.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,423.36
|
| Rate for Payer: Cigna of CA PPO |
$1,645.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
IP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$444.80 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$889.60
|
| Rate for Payer: EPIC Health Plan Senior |
$889.60
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,312.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
|
|
HC CHEMO ADMIN CNS W SPINAL TAP
|
Facility
|
OP
|
$2,224.00
|
|
|
Service Code
|
CPT 96450
|
| Hospital Charge Code |
911800816
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$219.48 |
| Max. Negotiated Rate |
$1,890.40 |
| Rate for Payer: Adventist Health Commercial |
$444.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$615.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cash Price |
$1,000.80
|
| Rate for Payer: Cigna of CA HMO |
$1,423.36
|
| Rate for Payer: Cigna of CA PPO |
$1,645.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,556.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,890.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,334.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,412.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$533.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,779.20
|
| Rate for Payer: Networks By Design Commercial |
$1,445.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,890.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,334.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,334.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
