|
HC PELVIC EXAM UNDER ANESTHESIA
|
Facility
|
OP
|
$7,672.00
|
|
|
Service Code
|
CPT 57410
|
| Hospital Charge Code |
900501650
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$142.48 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$1,534.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,452.40
|
| Rate for Payer: Cash Price |
$3,452.40
|
| Rate for Payer: Cash Price |
$3,452.40
|
| Rate for Payer: Cigna of CA HMO |
$4,910.08
|
| Rate for Payer: Cigna of CA PPO |
$5,677.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,521.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,603.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,117.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,841.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$6,137.60
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,986.80
|
| Rate for Payer: Prime Health Services Commercial |
$6,521.20
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,603.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,836.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,836.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,836.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$1,215.50 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$828.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.34
|
| Rate for Payer: Blue Shield of California EPN |
$694.98
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$518.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$1,215.50 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$828.26
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.34
|
| Rate for Payer: Blue Shield of California EPN |
$694.98
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$518.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$953.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$885.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIMMETRY
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
|
|
HC PELVIMMETRY
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.31
|
| Rate for Payer: Blue Shield of California Commercial |
$317.02
|
| Rate for Payer: Blue Shield of California EPN |
$209.27
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$440.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$440.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$362.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$362.60
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.30
|
| Rate for Payer: Vantage Medical Group Senior |
$440.30
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.40
|
| Rate for Payer: EPIC Health Plan Senior |
$258.40
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$399.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.04
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.32 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$423.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.49
|
| Rate for Payer: Blue Shield of California Commercial |
$395.35
|
| Rate for Payer: Blue Shield of California EPN |
$260.98
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO |
$413.44
|
| Rate for Payer: Cigna of CA PPO |
$478.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$878.90 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.60
|
| Rate for Payer: EPIC Health Plan Senior |
$413.60
|
| Rate for Payer: Galaxy Health WC |
$878.90
|
| Rate for Payer: Global Benefits Group Commercial |
$620.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$393.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$640.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.16
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: Networks By Design Commercial |
$672.10
|
| Rate for Payer: Prime Health Services Commercial |
$878.90
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$878.90 |
| Rate for Payer: Galaxy Health WC |
$878.90
|
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$678.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.38
|
| Rate for Payer: Blue Shield of California Commercial |
$632.81
|
| Rate for Payer: Blue Shield of California EPN |
$417.74
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO |
$661.76
|
| Rate for Payer: Cigna of CA PPO |
$765.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Global Benefits Group Commercial |
$620.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$689.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: Networks By Design Commercial |
$672.10
|
| Rate for Payer: Prime Health Services Commercial |
$878.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$620.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$620.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PENILE INJECTION
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,466.25 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$657.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,067.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Networks By Design Commercial |
$1,121.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
|
|
HC PENILE INJECTION
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$309.02 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cigna of CA HMO |
$1,104.00
|
| Rate for Payer: Cigna of CA PPO |
$1,276.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,150.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$657.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$389.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,121.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$862.50
|
| Rate for Payer: United Healthcare All Other HMO |
$862.50
|
| Rate for Payer: United Healthcare HMO Rider |
$862.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
OP
|
$1,691.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$135.12 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$338.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,109.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,038.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,034.89
|
| Rate for Payer: Blue Shield of California EPN |
$683.16
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cigna of CA HMO |
$1,082.24
|
| Rate for Payer: Cigna of CA PPO |
$1,251.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,437.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Networks By Design Commercial |
$1,099.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,437.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
IP
|
$1,691.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$338.20 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Adventist Health Commercial |
$338.20
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.40
|
| Rate for Payer: EPIC Health Plan Senior |
$676.40
|
| Rate for Payer: Galaxy Health WC |
$1,437.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,046.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.84
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Networks By Design Commercial |
$1,099.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,437.35
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
IP
|
$14,091.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,818.20 |
| Max. Negotiated Rate |
$11,977.35 |
| Rate for Payer: Adventist Health Commercial |
$2,818.20
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,636.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,636.40
|
| Rate for Payer: Galaxy Health WC |
$11,977.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,454.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,368.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,722.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,381.84
|
| Rate for Payer: Multiplan Commercial |
$11,272.80
|
| Rate for Payer: Networks By Design Commercial |
$9,159.15
|
| Rate for Payer: Prime Health Services Commercial |
$11,977.35
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
OP
|
$14,091.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,059.02 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,818.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Cigna of CA HMO |
$9,018.24
|
| Rate for Payer: Cigna of CA PPO |
$10,427.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$11,977.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,454.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,059.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,398.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,328.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,381.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$11,272.80
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$9,159.15
|
| Rate for Payer: Prime Health Services Commercial |
$11,977.35
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,454.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
IP
|
$13,877.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,775.40 |
| Max. Negotiated Rate |
$11,795.45 |
| Rate for Payer: Adventist Health Commercial |
$2,775.40
|
| Rate for Payer: Cash Price |
$6,244.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,550.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,550.80
|
| Rate for Payer: Galaxy Health WC |
$11,795.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,326.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,255.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,287.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,589.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,330.48
|
| Rate for Payer: Multiplan Commercial |
$11,101.60
|
| Rate for Payer: Networks By Design Commercial |
$9,020.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,795.45
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
OP
|
$13,877.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,533.14 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,775.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,484.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$6,244.65
|
| Rate for Payer: Cash Price |
$6,244.65
|
| Rate for Payer: Cash Price |
$6,244.65
|
| Rate for Payer: Cigna of CA HMO |
$8,881.28
|
| Rate for Payer: Cigna of CA PPO |
$10,268.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,932.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,484.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,053.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4,484.02
|
| Rate for Payer: Galaxy Health WC |
$11,795.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,326.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,353.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,533.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,484.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,255.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,864.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,484.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,330.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,649.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,008.59
|
| Rate for Payer: Multiplan Commercial |
$11,101.60
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$9,020.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,795.45
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,326.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,484.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,726.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,932.42
|
| Rate for Payer: Vantage Medical Group Senior |
$4,484.02
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$7,942.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,588.40 |
| Max. Negotiated Rate |
$6,750.70 |
| Rate for Payer: Adventist Health Commercial |
$1,588.40
|
| Rate for Payer: Cash Price |
$3,573.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,176.80
|
| Rate for Payer: Galaxy Health WC |
$6,750.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,765.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,297.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,025.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,916.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.08
|
| Rate for Payer: Multiplan Commercial |
$6,353.60
|
| Rate for Payer: Networks By Design Commercial |
$5,162.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,750.70
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$7,942.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,497.37 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,588.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$3,573.90
|
| Rate for Payer: Cash Price |
$3,573.90
|
| Rate for Payer: Cash Price |
$3,573.90
|
| Rate for Payer: Cigna of CA HMO |
$5,082.88
|
| Rate for Payer: Cigna of CA PPO |
$5,877.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$6,750.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,765.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,497.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,297.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,693.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$6,353.60
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$5,162.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,750.70
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,765.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
IP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$2,046.80 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$917.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,490.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
OP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,324.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,478.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,473.70
|
| Rate for Payer: Blue Shield of California EPN |
$972.83
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna of CA HMO |
$1,541.12
|
| Rate for Payer: Cigna of CA PPO |
$1,781.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,046.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,046.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,490.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,685.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,685.60
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,444.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,444.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,046.80
|
|
|
HC PERC HC TRANSCATH ABLTN PULM ARTERIES RH CATH
|
Facility
|
OP
|
$47,609.00
|
|
|
Service Code
|
CPT 0793T
|
| Hospital Charge Code |
906819786
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$40,467.65 |
| Rate for Payer: Adventist Health Commercial |
$9,521.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,236.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$21,424.05
|
| Rate for Payer: Cash Price |
$21,424.05
|
| Rate for Payer: Cash Price |
$21,424.05
|
| Rate for Payer: Cigna of CA HMO |
$30,469.76
|
| Rate for Payer: Cigna of CA PPO |
$35,230.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$40,467.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,565.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,755.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,139.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,426.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$38,087.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$30,945.85
|
| Rate for Payer: Prime Health Services Commercial |
$40,467.65
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,565.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,804.50
|
| Rate for Payer: United Healthcare All Other HMO |
$23,804.50
|
| Rate for Payer: United Healthcare HMO Rider |
$23,804.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23,804.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERC HC TRANSCATH ABLTN PULM ARTERIES RH CATH
|
Facility
|
IP
|
$47,609.00
|
|
|
Service Code
|
CPT 0793T
|
| Hospital Charge Code |
906819786
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,521.80 |
| Max. Negotiated Rate |
$40,467.65 |
| Rate for Payer: Adventist Health Commercial |
$9,521.80
|
| Rate for Payer: Cash Price |
$21,424.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,043.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,043.60
|
| Rate for Payer: Galaxy Health WC |
$40,467.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,565.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,755.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,139.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,469.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,426.16
|
| Rate for Payer: Multiplan Commercial |
$38,087.20
|
| Rate for Payer: Networks By Design Commercial |
$30,945.85
|
| Rate for Payer: Prime Health Services Commercial |
$40,467.65
|
|
