|
HC PERC RF ABLATION, RENAL TUMOR
|
Facility
|
IP
|
$21,689.00
|
|
|
Service Code
|
CPT 50592
|
| Hospital Charge Code |
909081854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,337.80 |
| Max. Negotiated Rate |
$18,435.65 |
| Rate for Payer: Adventist Health Commercial |
$4,337.80
|
| Rate for Payer: Cash Price |
$9,760.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,675.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,675.60
|
| Rate for Payer: Galaxy Health WC |
$18,435.65
|
| Rate for Payer: Global Benefits Group Commercial |
$13,013.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,466.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,263.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,425.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,205.36
|
| Rate for Payer: Multiplan Commercial |
$17,351.20
|
| Rate for Payer: Networks By Design Commercial |
$14,097.85
|
| Rate for Payer: Prime Health Services Commercial |
$18,435.65
|
|
|
HC PERC SKEL FIX OF FEM FRAC
|
Facility
|
IP
|
$7,001.00
|
|
|
Service Code
|
CPT 27509
|
| Hospital Charge Code |
900501086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,400.20 |
| Max. Negotiated Rate |
$5,950.85 |
| Rate for Payer: Adventist Health Commercial |
$1,400.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,166.74
|
| Rate for Payer: Blue Shield of California EPN |
$3,402.49
|
| Rate for Payer: Cash Price |
$3,150.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,800.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,800.40
|
| Rate for Payer: Galaxy Health WC |
$5,950.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,200.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,667.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,333.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,680.24
|
| Rate for Payer: Multiplan Commercial |
$5,600.80
|
| Rate for Payer: Networks By Design Commercial |
$4,550.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,950.85
|
|
|
HC PERC SKEL FIX OF FEM FRAC
|
Facility
|
OP
|
$7,001.00
|
|
|
Service Code
|
CPT 27509
|
| Hospital Charge Code |
900501086
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.06 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$1,400.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,150.45
|
| Rate for Payer: Cash Price |
$3,150.45
|
| Rate for Payer: Cash Price |
$3,150.45
|
| Rate for Payer: Cigna of CA HMO |
$4,480.64
|
| Rate for Payer: Cigna of CA PPO |
$5,180.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$5,950.85
|
| Rate for Payer: Global Benefits Group Commercial |
$4,200.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,669.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,680.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$5,600.80
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$4,550.65
|
| Rate for Payer: Prime Health Services Commercial |
$5,950.85
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,200.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,500.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,500.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,500.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,500.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC PERC SKEL FIX OF FEM FRAC PROX
|
Facility
|
OP
|
$4,806.00
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
900501082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$961.20 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$961.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Cash Price |
$2,162.70
|
| Rate for Payer: Cash Price |
$2,162.70
|
| Rate for Payer: Cash Price |
$2,162.70
|
| Rate for Payer: Cigna of CA HMO |
$3,075.84
|
| Rate for Payer: Cigna of CA PPO |
$3,556.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$4,085.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,883.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,205.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,556.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$3,844.80
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$3,123.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,085.10
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,883.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,403.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,403.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,403.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,403.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC PERC SKEL FIX OF FEM FRAC PROX
|
Facility
|
IP
|
$4,806.00
|
|
|
Service Code
|
CPT 27235
|
| Hospital Charge Code |
900501082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$961.20 |
| Max. Negotiated Rate |
$4,085.10 |
| Rate for Payer: Adventist Health Commercial |
$961.20
|
| Rate for Payer: Cash Price |
$2,162.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,922.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,922.40
|
| Rate for Payer: Galaxy Health WC |
$4,085.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,883.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,205.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,831.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,974.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,153.44
|
| Rate for Payer: Multiplan Commercial |
$3,844.80
|
| Rate for Payer: Networks By Design Commercial |
$3,123.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,085.10
|
|
|
HC PERC THROMB DIALYSIS CRCT
|
Facility
|
OP
|
$16,668.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,719.52 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$3,333.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| 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 |
$7,415.66
|
| Rate for Payer: Cash Price |
$7,500.60
|
| Rate for Payer: Cash Price |
$7,500.60
|
| Rate for Payer: Cash Price |
$7,500.60
|
| Rate for Payer: Cigna of CA HMO |
$10,667.52
|
| Rate for Payer: Cigna of CA PPO |
$12,334.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$14,167.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,000.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,719.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,117.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,075.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,000.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$13,334.40
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$10,834.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,167.80
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,000.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC PERC THROMB DIALYSIS CRCT
|
Facility
|
IP
|
$16,668.00
|
|
|
Service Code
|
CPT 36904
|
| Hospital Charge Code |
909036904
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,333.60 |
| Max. Negotiated Rate |
$14,167.80 |
| Rate for Payer: Adventist Health Commercial |
$3,333.60
|
| Rate for Payer: Cash Price |
$7,500.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,667.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,667.20
|
| Rate for Payer: Galaxy Health WC |
$14,167.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,000.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,117.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,350.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,317.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,000.32
|
| Rate for Payer: Multiplan Commercial |
$13,334.40
|
| Rate for Payer: Networks By Design Commercial |
$10,834.20
|
| Rate for Payer: Prime Health Services Commercial |
$14,167.80
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
|
IP
|
$6,826.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,365.20 |
| Max. Negotiated Rate |
$5,802.10 |
| Rate for Payer: Adventist Health Commercial |
$1,365.20
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,730.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,730.40
|
| Rate for Payer: Galaxy Health WC |
$5,802.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,552.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,600.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,225.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,638.24
|
| Rate for Payer: Multiplan Commercial |
$5,460.80
|
| Rate for Payer: Networks By Design Commercial |
$4,436.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,802.10
|
|
|
HC PERCT PLCMNT DUODENAL/JEJUNOST
|
Facility
|
OP
|
$6,826.00
|
|
|
Service Code
|
CPT 49441
|
| Hospital Charge Code |
909020003
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,365.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,365.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$3,071.70
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: Cash Price |
$3,071.70
|
| Rate for Payer: Cigna of CA HMO |
$4,368.64
|
| Rate for Payer: Cigna of CA PPO |
$5,051.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$5,802.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,095.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,837.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,552.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,078.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,638.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$5,460.80
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$4,436.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,802.10
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,095.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
OP
|
$6,570.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.41 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$1,314.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,309.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$4,020.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,654.28
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: Cigna of CA HMO |
$4,204.80
|
| Rate for Payer: Cigna of CA PPO |
$4,861.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$5,584.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$207.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,382.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$234.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$5,256.00
|
| Rate for Payer: Networks By Design Commercial |
$4,270.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,584.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,942.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,942.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,341.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5,341.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5,341.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,341.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PERC TRANSPORTAL W HEMO
|
Facility
|
IP
|
$6,570.00
|
|
|
Service Code
|
CPT 75885
|
| Hospital Charge Code |
909081690
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,314.00 |
| Max. Negotiated Rate |
$5,584.50 |
| Rate for Payer: Adventist Health Commercial |
$1,314.00
|
| Rate for Payer: Cash Price |
$2,956.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,628.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,628.00
|
| Rate for Payer: Galaxy Health WC |
$5,584.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,942.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,382.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,503.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,066.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,576.80
|
| Rate for Payer: Multiplan Commercial |
$5,256.00
|
| Rate for Payer: Networks By Design Commercial |
$4,270.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,584.50
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
IP
|
$3,021.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$604.20 |
| Max. Negotiated Rate |
$2,567.85 |
| Rate for Payer: Adventist Health Commercial |
$604.20
|
| Rate for Payer: Cash Price |
$1,359.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,208.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,208.40
|
| Rate for Payer: Galaxy Health WC |
$2,567.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,812.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,015.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,151.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,870.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.04
|
| Rate for Payer: Multiplan Commercial |
$2,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,963.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,567.85
|
|
|
HC PERC TRANSPORTAL W/O HEMO
|
Facility
|
OP
|
$3,021.00
|
|
|
Service Code
|
CPT 75887
|
| Hospital Charge Code |
909081691
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$604.20 |
| Max. Negotiated Rate |
$6,558.70 |
| Rate for Payer: Adventist Health Commercial |
$604.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,981.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,560.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1,848.85
|
| Rate for Payer: Blue Shield of California EPN |
$1,220.48
|
| Rate for Payer: Cash Price |
$1,359.45
|
| Rate for Payer: Cash Price |
$1,359.45
|
| Rate for Payer: Cigna of CA HMO |
$1,933.44
|
| Rate for Payer: Cigna of CA PPO |
$2,235.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$2,567.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,812.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,015.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$725.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$2,416.80
|
| Rate for Payer: Networks By Design Commercial |
$1,963.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,567.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,812.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,812.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,688.24
|
| Rate for Payer: United Healthcare All Other HMO |
$1,688.24
|
| Rate for Payer: United Healthcare HMO Rider |
$1,688.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,688.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
OP
|
$25,990.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
909033897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.12 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,198.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,091.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,294.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,492.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$11,695.50
|
| Rate for Payer: Cash Price |
$11,695.50
|
| Rate for Payer: Cash Price |
$11,695.50
|
| Rate for Payer: Cigna of CA HMO |
$16,633.60
|
| Rate for Payer: Cigna of CA PPO |
$19,232.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,091.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,091.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,091.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,396.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,396.00
|
| Rate for Payer: Galaxy Health WC |
$22,091.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15,594.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,335.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,087.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,237.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,193.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,193.00
|
| Rate for Payer: Multiplan Commercial |
$20,792.00
|
| Rate for Payer: Networks By Design Commercial |
$16,893.50
|
| Rate for Payer: Prime Health Services Commercial |
$22,091.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,594.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,091.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,091.50
|
| Rate for Payer: Vantage Medical Group Senior |
$22,091.50
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
IP
|
$25,260.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
906820290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,052.00 |
| Max. Negotiated Rate |
$21,471.00 |
| Rate for Payer: Adventist Health Commercial |
$5,052.00
|
| Rate for Payer: Cash Price |
$11,367.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,104.00
|
| Rate for Payer: Galaxy Health WC |
$21,471.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,156.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,848.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,624.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,635.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,062.40
|
| Rate for Payer: Multiplan Commercial |
$20,208.00
|
| Rate for Payer: Networks By Design Commercial |
$16,419.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,471.00
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
IP
|
$25,990.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
909033897
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,198.00 |
| Max. Negotiated Rate |
$22,091.50 |
| Rate for Payer: Adventist Health Commercial |
$5,198.00
|
| Rate for Payer: Cash Price |
$11,695.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,396.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,396.00
|
| Rate for Payer: Galaxy Health WC |
$22,091.50
|
| Rate for Payer: Global Benefits Group Commercial |
$15,594.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17,335.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,902.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,087.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,237.60
|
| Rate for Payer: Multiplan Commercial |
$20,792.00
|
| Rate for Payer: Networks By Design Commercial |
$16,893.50
|
| Rate for Payer: Prime Health Services Commercial |
$22,091.50
|
|
|
HC PERC TRLUML ANGP NAT/RECR COA
|
Facility
|
OP
|
$25,260.00
|
|
|
Service Code
|
CPT 33897
|
| Hospital Charge Code |
906820290
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$160.12 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,052.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,471.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,893.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,945.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$11,367.00
|
| Rate for Payer: Cash Price |
$11,367.00
|
| Rate for Payer: Cash Price |
$11,367.00
|
| Rate for Payer: Cigna of CA HMO |
$16,166.40
|
| Rate for Payer: Cigna of CA PPO |
$18,692.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,471.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,471.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,471.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10,104.00
|
| Rate for Payer: Galaxy Health WC |
$21,471.00
|
| Rate for Payer: Global Benefits Group Commercial |
$15,156.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$160.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,848.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,635.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,062.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,682.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,682.00
|
| Rate for Payer: Multiplan Commercial |
$20,208.00
|
| Rate for Payer: Networks By Design Commercial |
$16,419.00
|
| Rate for Payer: Prime Health Services Commercial |
$21,471.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,156.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,471.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,471.00
|
| Rate for Payer: Vantage Medical Group Senior |
$21,471.00
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
IP
|
$14,005.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,801.00 |
| Max. Negotiated Rate |
$11,904.25 |
| Rate for Payer: Adventist Health Commercial |
$2,801.00
|
| Rate for Payer: Cash Price |
$6,302.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,602.00
|
| Rate for Payer: Galaxy Health WC |
$11,904.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,403.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,341.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,335.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,669.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,361.20
|
| Rate for Payer: Multiplan Commercial |
$11,204.00
|
| Rate for Payer: Networks By Design Commercial |
$9,103.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,904.25
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
OP
|
$14,005.00
|
|
|
Service Code
|
CPT 92972
|
| Hospital Charge Code |
906811715
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$11,904.25 |
| Rate for Payer: Adventist Health Commercial |
$2,801.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,904.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,702.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,503.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,600.47
|
| 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 |
$6,302.25
|
| Rate for Payer: Cash Price |
$6,302.25
|
| Rate for Payer: Cigna of CA HMO |
$8,963.20
|
| Rate for Payer: Cigna of CA PPO |
$10,363.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,904.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,904.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,904.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,602.00
|
| Rate for Payer: Galaxy Health WC |
$11,904.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,403.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,341.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,669.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,361.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,803.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,803.50
|
| Rate for Payer: Multiplan Commercial |
$11,204.00
|
| Rate for Payer: Networks By Design Commercial |
$9,103.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,904.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,403.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,002.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,002.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,002.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,002.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,904.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,904.25
|
| Rate for Payer: Vantage Medical Group Senior |
$11,904.25
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
IP
|
$16,477.00
|
|
|
Service Code
|
CPT 0715T
|
| Hospital Charge Code |
906820294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,295.40 |
| Max. Negotiated Rate |
$14,005.45 |
| Rate for Payer: Adventist Health Commercial |
$3,295.40
|
| Rate for Payer: Cash Price |
$7,414.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,590.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,590.80
|
| Rate for Payer: Galaxy Health WC |
$14,005.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,886.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,990.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,277.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,199.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,954.48
|
| Rate for Payer: Multiplan Commercial |
$13,181.60
|
| Rate for Payer: Networks By Design Commercial |
$10,710.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,005.45
|
|
|
HC PERC TRNSLUMNL CORO LITHOTRIPSY
|
Facility
|
OP
|
$16,477.00
|
|
|
Service Code
|
CPT 0715T
|
| Hospital Charge Code |
906820294
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$570.02 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,295.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14,005.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,062.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,357.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,118.53
|
| 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 |
$7,414.65
|
| Rate for Payer: Cash Price |
$7,414.65
|
| Rate for Payer: Cigna of CA HMO |
$10,545.28
|
| Rate for Payer: Cigna of CA PPO |
$12,192.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14,005.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,005.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,005.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,590.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,590.80
|
| Rate for Payer: Galaxy Health WC |
$14,005.45
|
| Rate for Payer: Global Benefits Group Commercial |
$9,886.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,990.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,277.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,199.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,954.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,533.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,533.90
|
| Rate for Payer: Multiplan Commercial |
$13,181.60
|
| Rate for Payer: Networks By Design Commercial |
$10,710.05
|
| Rate for Payer: Prime Health Services Commercial |
$14,005.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,886.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14,005.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,005.45
|
| Rate for Payer: Vantage Medical Group Senior |
$14,005.45
|
|
|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
OP
|
$16,804.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$302.04 |
| Max. Negotiated Rate |
$14,283.40 |
| Rate for Payer: Adventist Health Commercial |
$3,360.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$7,561.80
|
| Rate for Payer: Cash Price |
$7,561.80
|
| Rate for Payer: Cash Price |
$7,561.80
|
| Rate for Payer: Cigna of CA HMO |
$10,754.56
|
| Rate for Payer: Cigna of CA PPO |
$12,434.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$14,283.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10,082.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,208.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$302.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,032.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$13,443.20
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$10,922.60
|
| Rate for Payer: Prime Health Services Commercial |
$14,283.40
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,082.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,402.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,402.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,402.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,402.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC PERC TRT FX GREAT TOE, W/MANIP
|
Facility
|
IP
|
$16,804.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
900501250
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,360.80 |
| Max. Negotiated Rate |
$14,283.40 |
| Rate for Payer: Adventist Health Commercial |
$3,360.80
|
| Rate for Payer: Cash Price |
$7,561.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,721.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,721.60
|
| Rate for Payer: Galaxy Health WC |
$14,283.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10,082.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,208.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,402.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,401.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,032.96
|
| Rate for Payer: Multiplan Commercial |
$13,443.20
|
| Rate for Payer: Networks By Design Commercial |
$10,922.60
|
| Rate for Payer: Prime Health Services Commercial |
$14,283.40
|
|
|
HC PERC T-TUBE CATH COOK MSPT1400
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.12
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
|
|
HC PERC T-TUBE CATH COOK MSPT1400
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001040
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$52.60 |
| Max. Negotiated Rate |
$223.55 |
| Rate for Payer: Adventist Health Commercial |
$52.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.33
|
| Rate for Payer: Blue Shield of California Commercial |
$194.09
|
| Rate for Payer: Blue Shield of California EPN |
$127.82
|
| Rate for Payer: Cash Price |
$118.35
|
| Rate for Payer: Cigna of CA HMO |
$184.10
|
| Rate for Payer: Cigna of CA PPO |
$184.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$223.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$223.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$223.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$105.20
|
| Rate for Payer: Galaxy Health WC |
$223.55
|
| Rate for Payer: Global Benefits Group Commercial |
$157.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$175.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$162.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.10
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Networks By Design Commercial |
$131.50
|
| Rate for Payer: Prime Health Services Commercial |
$223.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.70
|
| Rate for Payer: United Healthcare All Other HMO |
$96.07
|
| Rate for Payer: United Healthcare HMO Rider |
$94.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$223.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$223.55
|
| Rate for Payer: Vantage Medical Group Senior |
$223.55
|
|
