|
HC I & D VAGINAL HEMATOMA
|
Facility
|
OP
|
$5,049.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,272.05
|
| Rate for Payer: Cash Price |
$2,272.05
|
| Rate for Payer: Cash Price |
$2,272.05
|
| Rate for Payer: Cigna of CA HMO |
$3,231.36
|
| Rate for Payer: Cigna of CA PPO |
$3,736.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$4,039.20
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,029.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,029.40
|
| 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: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
IP
|
$5,049.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,009.80 |
| Max. Negotiated Rate |
$4,291.65 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Cash Price |
$2,272.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,019.60
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,125.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.76
|
| Rate for Payer: Multiplan Commercial |
$4,039.20
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
IP
|
$5,049.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,009.80 |
| Max. Negotiated Rate |
$4,291.65 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Cash Price |
$2,272.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,019.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,019.60
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,125.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.76
|
| Rate for Payer: Multiplan Commercial |
$4,039.20
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
|
|
HC I & D VAGINAL HEMATOMA
|
Facility
|
OP
|
$5,049.00
|
|
|
Service Code
|
CPT 57022
|
| Hospital Charge Code |
902400747
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,009.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,636.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,272.05
|
| Rate for Payer: Cash Price |
$2,272.05
|
| Rate for Payer: Cash Price |
$2,272.05
|
| Rate for Payer: Cigna of CA HMO |
$3,231.36
|
| Rate for Payer: Cigna of CA PPO |
$3,736.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,000.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,636.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,909.30
|
| Rate for Payer: EPIC Health Plan Senior |
$3,636.52
|
| Rate for Payer: Galaxy Health WC |
$4,291.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,029.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$5,963.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,636.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,367.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,923.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,636.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,211.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,582.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,872.94
|
| Rate for Payer: Multiplan Commercial |
$4,039.20
|
| Rate for Payer: Multiplan WC |
$5,794.14
|
| Rate for Payer: Networks By Design Commercial |
$3,281.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,291.65
|
| Rate for Payer: Prime Health Services WC |
$5,735.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,029.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,524.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,524.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,524.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,524.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,636.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,454.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,000.17
|
| Rate for Payer: Vantage Medical Group Senior |
$3,636.52
|
|
|
HC IHC EACH ADDL SINGLE MULTI PER SPEC MEDI
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800243
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Senior |
$264.00
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$408.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
|
|
HC IHC EACH ADDL SINGLE MULTI PER SPEC MEDI
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 88344
|
| Hospital Charge Code |
903800243
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$432.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$738.05
|
| Rate for Payer: Blue Shield of California Commercial |
$441.54
|
| Rate for Payer: Blue Shield of California EPN |
$291.72
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO |
$422.40
|
| Rate for Payer: Cigna of CA PPO |
$488.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$176.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$396.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$396.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC IHC FIRST SINGLE MULTI PER SPEC MEDI
|
Facility
|
OP
|
$534.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800242
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$90.37 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$350.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.16
|
| Rate for Payer: Blue Shield of California Commercial |
$357.25
|
| Rate for Payer: Blue Shield of California EPN |
$236.03
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: Cigna of CA HMO |
$341.76
|
| Rate for Payer: Cigna of CA PPO |
$395.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$453.90
|
| Rate for Payer: Global Benefits Group Commercial |
$320.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$90.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$274.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Networks By Design Commercial |
$347.10
|
| Rate for Payer: Prime Health Services Commercial |
$453.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$320.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$320.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC IHC FIRST SINGLE MULTI PER SPEC MEDI
|
Facility
|
IP
|
$534.00
|
|
|
Service Code
|
CPT 88342
|
| Hospital Charge Code |
903800242
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$453.90 |
| Rate for Payer: Adventist Health Commercial |
$106.80
|
| Rate for Payer: Cash Price |
$240.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$213.60
|
| Rate for Payer: EPIC Health Plan Senior |
$213.60
|
| Rate for Payer: Galaxy Health WC |
$453.90
|
| Rate for Payer: Global Benefits Group Commercial |
$320.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$203.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$128.16
|
| Rate for Payer: Multiplan Commercial |
$427.20
|
| Rate for Payer: Networks By Design Commercial |
$347.10
|
| Rate for Payer: Prime Health Services Commercial |
$453.90
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
OP
|
$3,280.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820131
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$92.90 |
| Max. Negotiated Rate |
$2,788.00 |
| Rate for Payer: Adventist Health Commercial |
$656.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,151.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,788.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,804.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,460.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.90
|
| Rate for Payer: Blue Shield of California Commercial |
$2,007.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,325.12
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: Cigna of CA HMO |
$2,099.20
|
| Rate for Payer: Cigna of CA PPO |
$2,427.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,788.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,788.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,788.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,312.00
|
| Rate for Payer: Galaxy Health WC |
$2,788.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,968.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,187.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,249.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,030.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,296.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,296.00
|
| Rate for Payer: Multiplan Commercial |
$2,624.00
|
| Rate for Payer: Networks By Design Commercial |
$2,132.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,788.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,968.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,968.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,640.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,640.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,640.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,640.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,788.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,788.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,788.00
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
IP
|
$3,280.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906820131
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$656.00 |
| Max. Negotiated Rate |
$2,788.00 |
| Rate for Payer: Adventist Health Commercial |
$656.00
|
| Rate for Payer: Cash Price |
$1,476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,312.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,312.00
|
| Rate for Payer: Galaxy Health WC |
$2,788.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,968.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,187.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,249.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,030.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$787.20
|
| Rate for Payer: Multiplan Commercial |
$2,624.00
|
| Rate for Payer: Networks By Design Commercial |
$2,132.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,788.00
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
IP
|
$2,424.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$484.80 |
| Max. Negotiated Rate |
$2,060.40 |
| Rate for Payer: Adventist Health Commercial |
$484.80
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$969.60
|
| Rate for Payer: EPIC Health Plan Senior |
$969.60
|
| Rate for Payer: Galaxy Health WC |
$2,060.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,454.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,616.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$923.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,500.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.76
|
| Rate for Payer: Multiplan Commercial |
$1,939.20
|
| Rate for Payer: Networks By Design Commercial |
$1,575.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,060.40
|
|
|
HC ILAC ART ANGIO CARDIAC CATH
|
Facility
|
OP
|
$2,424.00
|
|
|
Service Code
|
CPT G0278
|
| Hospital Charge Code |
906811387
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$92.90 |
| Max. Negotiated Rate |
$2,060.40 |
| Rate for Payer: Adventist Health Commercial |
$484.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,589.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,060.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,333.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,818.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,483.49
|
| Rate for Payer: Blue Shield of California EPN |
$979.30
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: Cigna of CA HMO |
$1,551.36
|
| Rate for Payer: Cigna of CA PPO |
$1,793.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,060.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,060.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,060.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$969.60
|
| Rate for Payer: EPIC Health Plan Senior |
$969.60
|
| Rate for Payer: Galaxy Health WC |
$2,060.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,454.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,616.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$923.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,500.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$581.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,696.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,696.80
|
| Rate for Payer: Multiplan Commercial |
$1,939.20
|
| Rate for Payer: Networks By Design Commercial |
$1,575.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,060.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,454.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,454.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,212.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,212.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,212.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,212.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,060.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,060.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,060.40
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$183.25 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cigna of CA HMO |
$3,435.52
|
| Rate for Payer: Cigna of CA PPO |
$3,972.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$4,562.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,220.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$183.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,580.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$207.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,294.40
|
| Rate for Payer: Networks By Design Commercial |
$3,489.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,562.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ILEOSCOPY STOMA W BX
|
Facility
|
IP
|
$5,796.00
|
|
|
Service Code
|
CPT 44382
|
| Hospital Charge Code |
906744382
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,159.20 |
| Max. Negotiated Rate |
$4,926.60 |
| Rate for Payer: Adventist Health Commercial |
$1,159.20
|
| Rate for Payer: Cash Price |
$2,608.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,318.40
|
| Rate for Payer: Galaxy Health WC |
$4,926.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,477.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,865.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,208.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,587.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,391.04
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: Networks By Design Commercial |
$3,767.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,926.60
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$141.36 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cigna of CA HMO |
$3,435.52
|
| Rate for Payer: Cigna of CA PPO |
$3,972.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$4,562.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,220.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$141.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,580.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,294.40
|
| Rate for Payer: Networks By Design Commercial |
$3,489.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,562.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,220.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
OP
|
$5,368.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$159.87 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,073.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cash Price |
$2,415.60
|
| Rate for Payer: Cigna of CA HMO |
$3,435.52
|
| Rate for Payer: Cigna of CA PPO |
$3,972.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$4,562.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,220.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,580.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$159.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,288.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$4,294.40
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$3,489.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,562.80
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,684.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,684.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,684.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,684.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
IP
|
$5,796.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,159.20 |
| Max. Negotiated Rate |
$4,926.60 |
| Rate for Payer: Adventist Health Commercial |
$1,159.20
|
| Rate for Payer: Cash Price |
$2,608.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,318.40
|
| Rate for Payer: Galaxy Health WC |
$4,926.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,477.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,865.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,208.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,587.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,391.04
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: Networks By Design Commercial |
$3,767.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,926.60
|
|
|
HC ILEOSCOPY STOMA W WO COLLECT
|
Facility
|
IP
|
$5,796.00
|
|
|
Service Code
|
CPT 44380
|
| Hospital Charge Code |
906744380
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,159.20 |
| Max. Negotiated Rate |
$4,926.60 |
| Rate for Payer: Adventist Health Commercial |
$1,159.20
|
| Rate for Payer: Cash Price |
$2,608.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,318.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,318.40
|
| Rate for Payer: Galaxy Health WC |
$4,926.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,477.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,865.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,208.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,587.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,391.04
|
| Rate for Payer: Multiplan Commercial |
$4,636.80
|
| Rate for Payer: Networks By Design Commercial |
$3,767.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,926.60
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
OP
|
$6,416.00
|
|
|
Service Code
|
CPT 44383
|
| Hospital Charge Code |
906744383
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,283.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,283.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,453.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,528.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,812.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,940.07
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,887.20
|
| Rate for Payer: Cash Price |
$2,887.20
|
| Rate for Payer: Cigna of CA HMO |
$4,106.24
|
| Rate for Payer: Cigna of CA PPO |
$4,747.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,453.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,453.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,453.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,566.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,566.40
|
| Rate for Payer: Galaxy Health WC |
$5,453.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,849.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,279.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,444.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,971.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,539.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,491.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,491.20
|
| Rate for Payer: Multiplan Commercial |
$5,132.80
|
| Rate for Payer: Networks By Design Commercial |
$4,170.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,453.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,849.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,849.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,208.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,208.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,208.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,453.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,453.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,453.60
|
|
|
HC ILEOSCOPY W/STNT PLCMNT
|
Facility
|
OP
|
$8,470.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,694.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,694.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$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 |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cash Price |
$3,811.50
|
| Rate for Payer: Cigna of CA HMO |
$5,420.80
|
| Rate for Payer: Cigna of CA PPO |
$6,267.80
|
| 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 |
$7,199.50
|
| Rate for Payer: Global Benefits Group Commercial |
$5,082.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,649.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,032.80
|
| 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 |
$6,776.00
|
| Rate for Payer: Networks By Design Commercial |
$5,505.50
|
| Rate for Payer: Prime Health Services Commercial |
$7,199.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,082.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| 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 ILEOSCOPY W/STNT PLCMNT
|
Facility
|
IP
|
$9,147.00
|
|
|
Service Code
|
CPT 44384
|
| Hospital Charge Code |
906744384
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,829.40 |
| Max. Negotiated Rate |
$7,774.95 |
| Rate for Payer: Adventist Health Commercial |
$1,829.40
|
| Rate for Payer: Cash Price |
$4,116.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,658.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,658.80
|
| Rate for Payer: Galaxy Health WC |
$7,774.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5,488.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,101.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,485.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,661.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,195.28
|
| Rate for Payer: Multiplan Commercial |
$7,317.60
|
| Rate for Payer: Networks By Design Commercial |
$5,945.55
|
| Rate for Payer: Prime Health Services Commercial |
$7,774.95
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
IP
|
$3,093.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$618.60 |
| Max. Negotiated Rate |
$2,629.05 |
| Rate for Payer: Adventist Health Commercial |
$618.60
|
| Rate for Payer: Cash Price |
$1,391.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,237.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,237.20
|
| Rate for Payer: Galaxy Health WC |
$2,629.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,855.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,063.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,178.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,914.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.32
|
| Rate for Payer: Multiplan Commercial |
$2,474.40
|
| Rate for Payer: Networks By Design Commercial |
$2,010.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,629.05
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, PERC
|
Facility
|
OP
|
$3,093.00
|
|
|
Service Code
|
CPT 49406
|
| Hospital Charge Code |
900100011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$309.61 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$618.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,391.85
|
| Rate for Payer: Cash Price |
$1,391.85
|
| Rate for Payer: Cash Price |
$1,391.85
|
| Rate for Payer: Cigna of CA HMO |
$1,979.52
|
| Rate for Payer: Cigna of CA PPO |
$2,288.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$2,629.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,855.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$309.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,063.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$350.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$742.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$2,474.40
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,010.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,629.05
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,855.80
|
| 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 |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.80 |
| Max. Negotiated Rate |
$1,856.40 |
| Rate for Payer: Adventist Health Commercial |
$436.80
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.60
|
| Rate for Payer: EPIC Health Plan Senior |
$873.60
|
| Rate for Payer: Galaxy Health WC |
$1,856.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,310.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,456.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$832.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,351.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.16
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: Networks By Design Commercial |
$1,419.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,856.40
|
|
|
HC IMAGE GUIDED FLUID COLL DRAIN CATH RETRO/PERITONEAL, TRANSVAG/TRANSREC
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
CPT 49407
|
| Hospital Charge Code |
900100012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$436.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$436.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cash Price |
$982.80
|
| Rate for Payer: Cigna of CA HMO |
$1,397.76
|
| Rate for Payer: Cigna of CA PPO |
$1,616.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$1,856.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,310.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$999.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,456.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,130.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$524.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,419.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,856.40
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,310.40
|
| 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 |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
