|
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 |
$568.70
|
| 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: 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 |
$568.70
|
| Rate for Payer: Cash Price |
$568.70
|
| 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: Galaxy Health WC |
$878.90
|
| 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 |
$948.75
|
| 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 |
$948.75
|
| Rate for Payer: Cash Price |
$948.75
|
| Rate for Payer: Cash Price |
$948.75
|
| 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 |
$930.05
|
| Rate for Payer: Cash Price |
$930.05
|
| Rate for Payer: Cash Price |
$930.05
|
| 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 |
$930.05
|
| 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 |
$7,750.05
|
| 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 |
$7,750.05
|
| Rate for Payer: Cash Price |
$7,750.05
|
| Rate for Payer: Cash Price |
$7,750.05
|
| 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 |
$7,632.35
|
| 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 |
$7,632.35
|
| Rate for Payer: Cash Price |
$7,632.35
|
| Rate for Payer: Cash Price |
$7,632.35
|
| 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
|
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 |
$4,368.10
|
| Rate for Payer: Cash Price |
$4,368.10
|
| Rate for Payer: Cash Price |
$4,368.10
|
| 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 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 |
$4,368.10
|
| 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 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 |
$1,324.40
|
| 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 |
$1,324.40
|
| Rate for Payer: Cash Price |
$1,324.40
|
| Rate for Payer: Cash Price |
$1,324.40
|
| 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 |
$26,184.95
|
| Rate for Payer: Cash Price |
$26,184.95
|
| Rate for Payer: Cash Price |
$26,184.95
|
| 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 |
$26,184.95
|
| 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
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
|
IP
|
$2,384.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$476.80 |
| Max. Negotiated Rate |
$2,026.40 |
| Rate for Payer: Adventist Health Commercial |
$476.80
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$953.60
|
| Rate for Payer: EPIC Health Plan Senior |
$953.60
|
| Rate for Payer: Galaxy Health WC |
$2,026.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,430.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,590.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$908.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,475.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.16
|
| Rate for Payer: Multiplan Commercial |
$1,907.20
|
| Rate for Payer: Networks By Design Commercial |
$1,549.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,026.40
|
|
|
HC PERC PLCMNT FIDUCIAL MRKR
|
Facility
|
OP
|
$2,384.00
|
|
|
Service Code
|
CPT 32553
|
| Hospital Charge Code |
900832553
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$476.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$476.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,738.51
|
| 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 |
$570.02
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: Cash Price |
$1,311.20
|
| Rate for Payer: Cigna of CA HMO |
$1,525.76
|
| Rate for Payer: Cigna of CA PPO |
$1,764.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,912.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,738.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,346.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,738.51
|
| Rate for Payer: Galaxy Health WC |
$2,026.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,430.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,851.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$872.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,738.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,590.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$986.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,738.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,190.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,329.60
|
| Rate for Payer: Multiplan Commercial |
$1,907.20
|
| Rate for Payer: Multiplan WC |
$2,770.01
|
| Rate for Payer: Networks By Design Commercial |
$1,549.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,026.40
|
| Rate for Payer: Prime Health Services WC |
$2,741.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,430.40
|
| 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 |
$1,738.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,607.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,912.36
|
| Rate for Payer: Vantage Medical Group Senior |
$1,738.51
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
IP
|
$25,085.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906811903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,017.00 |
| Max. Negotiated Rate |
$21,322.25 |
| Rate for Payer: Adventist Health Commercial |
$5,017.00
|
| Rate for Payer: Cash Price |
$13,796.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,034.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,034.00
|
| Rate for Payer: Galaxy Health WC |
$21,322.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,051.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,731.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,557.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,527.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,020.40
|
| Rate for Payer: Multiplan Commercial |
$20,068.00
|
| Rate for Payer: Networks By Design Commercial |
$16,305.25
|
| Rate for Payer: Prime Health Services Commercial |
$21,322.25
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
OP
|
$25,085.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906811903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,845.77 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,017.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| 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 |
$13,796.75
|
| Rate for Payer: Cash Price |
$13,796.75
|
| Rate for Payer: Cash Price |
$13,796.75
|
| Rate for Payer: Cigna of CA HMO |
$16,054.40
|
| Rate for Payer: Cigna of CA PPO |
$18,562.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$21,322.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15,051.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,731.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,020.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$20,068.00
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$16,305.25
|
| Rate for Payer: Prime Health Services Commercial |
$21,322.25
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,051.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
IP
|
$29,512.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906820326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,902.40 |
| Max. Negotiated Rate |
$25,085.20 |
| Rate for Payer: Adventist Health Commercial |
$5,902.40
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,804.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,804.80
|
| Rate for Payer: Galaxy Health WC |
$25,085.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,684.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,244.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,267.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,082.88
|
| Rate for Payer: Multiplan Commercial |
$23,609.60
|
| Rate for Payer: Networks By Design Commercial |
$19,182.80
|
| Rate for Payer: Prime Health Services Commercial |
$25,085.20
|
|
|
HC PERC PULM ART STENT ABN BI
|
Facility
|
OP
|
$29,512.00
|
|
|
Service Code
|
CPT 33903
|
| Hospital Charge Code |
906820326
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,845.77 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$5,902.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| 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 |
$16,231.60
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: Cash Price |
$16,231.60
|
| Rate for Payer: Cigna of CA HMO |
$18,887.68
|
| Rate for Payer: Cigna of CA PPO |
$21,838.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$25,085.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,707.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,684.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,082.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$23,609.60
|
| Rate for Payer: Multiplan WC |
$22,958.69
|
| Rate for Payer: Networks By Design Commercial |
$19,182.80
|
| Rate for Payer: Prime Health Services Commercial |
$25,085.20
|
| Rate for Payer: Prime Health Services WC |
$22,724.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,707.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC PERC PULM ART STENT ABN UNI
|
Facility
|
IP
|
$45,368.00
|
|
|
Service Code
|
CPT 33902
|
| Hospital Charge Code |
906820322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,073.60 |
| Max. Negotiated Rate |
$38,562.80 |
| Rate for Payer: Adventist Health Commercial |
$9,073.60
|
| Rate for Payer: Cash Price |
$24,952.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,147.20
|
| Rate for Payer: EPIC Health Plan Senior |
$18,147.20
|
| Rate for Payer: Galaxy Health WC |
$38,562.80
|
| Rate for Payer: Global Benefits Group Commercial |
$27,220.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30,260.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,285.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,082.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,888.32
|
| Rate for Payer: Multiplan Commercial |
$36,294.40
|
| Rate for Payer: Networks By Design Commercial |
$29,489.20
|
| Rate for Payer: Prime Health Services Commercial |
$38,562.80
|
|
|
HC PERC PULM ART STENT ABN UNI
|
Facility
|
OP
|
$45,368.00
|
|
|
Service Code
|
CPT 33902
|
| Hospital Charge Code |
906820322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,845.77 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,073.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15,192.00
|
| 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 |
$15,561.00
|
| 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 |
$24,952.40
|
| Rate for Payer: Cash Price |
$24,952.40
|
| Rate for Payer: Cash Price |
$24,952.40
|
| Rate for Payer: Cigna of CA HMO |
$29,035.52
|
| Rate for Payer: Cigna of CA PPO |
$33,572.32
|
| 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 |
$38,562.80
|
| Rate for Payer: Global Benefits Group Commercial |
$27,220.80
|
| 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 |
$30,260.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,888.32
|
| 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 |
$36,294.40
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$29,489.20
|
| Rate for Payer: Prime Health Services Commercial |
$38,562.80
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27,220.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| 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 PULM ART STENT ABN UNI
|
Facility
|
IP
|
$46,681.00
|
|
|
Service Code
|
CPT 33902
|
| Hospital Charge Code |
906811902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,336.20 |
| Max. Negotiated Rate |
$39,678.85 |
| Rate for Payer: Adventist Health Commercial |
$9,336.20
|
| Rate for Payer: Cash Price |
$25,674.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,672.40
|
| Rate for Payer: EPIC Health Plan Senior |
$18,672.40
|
| Rate for Payer: Galaxy Health WC |
$39,678.85
|
| Rate for Payer: Global Benefits Group Commercial |
$28,008.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,136.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,785.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28,895.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,203.44
|
| Rate for Payer: Multiplan Commercial |
$37,344.80
|
| Rate for Payer: Networks By Design Commercial |
$30,342.65
|
| Rate for Payer: Prime Health Services Commercial |
$39,678.85
|
|
