|
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 |
$3,613.50
|
| 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 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 |
$3,613.50
|
| Rate for Payer: Cash Price |
$3,613.50
|
| 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/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 |
$1,661.55
|
| Rate for Payer: Cash Price |
$1,661.55
|
| 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 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 |
$1,661.55
|
| 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 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 |
$13,893.00
|
| 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
|
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 |
$14,294.50
|
| Rate for Payer: Cash Price |
$14,294.50
|
| Rate for Payer: Cash Price |
$14,294.50
|
| 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
|
$25,990.00
|
|
|
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 |
$14,294.50
|
| 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 |
$13,893.00
|
| Rate for Payer: Cash Price |
$13,893.00
|
| Rate for Payer: Cash Price |
$13,893.00
|
| 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
|
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 |
$9,062.35
|
| Rate for Payer: Cash Price |
$9,062.35
|
| 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 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 |
$9,062.35
|
| 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
|
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 |
$7,702.75
|
| 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 |
$7,702.75
|
| Rate for Payer: Cash Price |
$7,702.75
|
| 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 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 |
$9,242.20
|
| Rate for Payer: Cash Price |
$9,242.20
|
| Rate for Payer: Cash Price |
$9,242.20
|
| 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 |
$9,242.20
|
| 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 |
$144.65
|
| Rate for Payer: Cash Price |
$144.65
|
| 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 |
$144.65
|
| 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
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$913.75 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Cash Price |
$591.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$665.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.00
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
|
|
HC PERCU INJ-ABLATIVE AGENT LIVER
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
CPT 47399
|
| Hospital Charge Code |
909081849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$660.16
|
| 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 |
$591.25
|
| Rate for Payer: Cash Price |
$591.25
|
| Rate for Payer: Cash Price |
$591.25
|
| Rate for Payer: Cigna of CA HMO |
$688.00
|
| Rate for Payer: Cigna of CA PPO |
$795.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$645.00
|
| 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: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
OP
|
$18,138.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,429.00 |
| Max. Negotiated Rate |
$26,811.67 |
| Rate for Payer: Adventist Health Commercial |
$3,627.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,348.58
|
| 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 |
$5,510.17
|
| Rate for Payer: Cash Price |
$9,975.90
|
| Rate for Payer: Cash Price |
$9,975.90
|
| Rate for Payer: Cash Price |
$9,975.90
|
| Rate for Payer: Cigna of CA HMO |
$11,608.32
|
| Rate for Payer: Cigna of CA PPO |
$13,422.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,983.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16,348.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,070.58
|
| Rate for Payer: EPIC Health Plan Senior |
$16,348.58
|
| Rate for Payer: Galaxy Health WC |
$15,417.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,882.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$26,811.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,178.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16,348.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,098.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,988.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16,348.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,353.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$20,599.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21,907.10
|
| Rate for Payer: Multiplan Commercial |
$14,510.40
|
| Rate for Payer: Multiplan WC |
$26,048.55
|
| Rate for Payer: Networks By Design Commercial |
$11,789.70
|
| Rate for Payer: Prime Health Services Commercial |
$15,417.30
|
| Rate for Payer: Prime Health Services WC |
$25,782.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,882.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$16,348.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24,522.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,983.44
|
| Rate for Payer: Vantage Medical Group Senior |
$16,348.58
|
|
|
HC PERCU RFA BONE INCLUDES CT GUI
|
Facility
|
IP
|
$18,138.00
|
|
|
Service Code
|
CPT 20982
|
| Hospital Charge Code |
909081838
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,627.60 |
| Max. Negotiated Rate |
$15,417.30 |
| Rate for Payer: Adventist Health Commercial |
$3,627.60
|
| Rate for Payer: Cash Price |
$9,975.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,255.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,255.20
|
| Rate for Payer: Galaxy Health WC |
$15,417.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,882.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,098.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,910.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,227.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,353.12
|
| Rate for Payer: Multiplan Commercial |
$14,510.40
|
| Rate for Payer: Networks By Design Commercial |
$11,789.70
|
| Rate for Payer: Prime Health Services Commercial |
$15,417.30
|
|
|
HC PERCU-STAY
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
909001085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
|
|
HC PERCU-STAY
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
909001085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$16.15 |
| Rate for Payer: Adventist Health Commercial |
$3.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.67
|
| Rate for Payer: Cash Price |
$10.45
|
| Rate for Payer: Cigna of CA HMO |
$12.16
|
| Rate for Payer: Cigna of CA PPO |
$14.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7.60
|
| Rate for Payer: Galaxy Health WC |
$16.15
|
| Rate for Payer: Global Benefits Group Commercial |
$11.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.30
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Networks By Design Commercial |
$12.35
|
| Rate for Payer: Prime Health Services Commercial |
$16.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9.50
|
| Rate for Payer: United Healthcare HMO Rider |
$9.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.15
|
| Rate for Payer: Vantage Medical Group Senior |
$16.15
|
|
|
HC PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
OP
|
$16,804.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$693.94 |
| 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 |
$9,242.20
|
| Rate for Payer: Cash Price |
$9,242.20
|
| Rate for Payer: Cash Price |
$9,242.20
|
| 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 |
$693.94
|
| 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 PERCUTANE DISTAL PHAL FRAC EA
|
Facility
|
IP
|
$16,804.00
|
|
|
Service Code
|
CPT 26756
|
| Hospital Charge Code |
900501333
|
|
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 |
$9,242.20
|
| 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 PERCUTANEOUS SHEATH INTRO 7FR
|
Facility
|
OP
|
$237.30
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901608009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$201.71 |
| Rate for Payer: Adventist Health Commercial |
$47.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$130.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.73
|
| Rate for Payer: Cash Price |
$130.52
|
| Rate for Payer: Cigna of CA HMO |
$151.87
|
| Rate for Payer: Cigna of CA PPO |
$175.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$201.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$201.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.92
|
| Rate for Payer: EPIC Health Plan Senior |
$94.92
|
| Rate for Payer: Galaxy Health WC |
$201.71
|
| Rate for Payer: Global Benefits Group Commercial |
$142.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$158.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$166.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$166.11
|
| Rate for Payer: Multiplan Commercial |
$189.84
|
| Rate for Payer: Networks By Design Commercial |
$154.25
|
| Rate for Payer: Prime Health Services Commercial |
$201.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$142.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$142.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$118.65
|
| Rate for Payer: United Healthcare All Other HMO |
$118.65
|
| Rate for Payer: United Healthcare HMO Rider |
$118.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$118.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$201.71
|
| Rate for Payer: Vantage Medical Group Senior |
$201.71
|
|
