|
HC PERCUTANEOUS SHEATH INTRO 7FR
|
Facility
|
IP
|
$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: Cash Price |
$130.52
|
| 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: Multiplan Commercial |
$189.84
|
| Rate for Payer: Networks By Design Commercial |
$154.25
|
| Rate for Payer: Prime Health Services Commercial |
$201.71
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
IP
|
$9,026.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,805.20 |
| Max. Negotiated Rate |
$7,672.10 |
| Rate for Payer: Adventist Health Commercial |
$1,805.20
|
| Rate for Payer: Cash Price |
$4,964.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,610.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,610.40
|
| Rate for Payer: Galaxy Health WC |
$7,672.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,415.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,020.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,438.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,587.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,166.24
|
| Rate for Payer: Multiplan Commercial |
$7,220.80
|
| Rate for Payer: Networks By Design Commercial |
$5,866.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,672.10
|
|
|
HC PERCUTANEOUS SKELETAL FIXATION
|
Facility
|
OP
|
$9,026.00
|
|
|
Service Code
|
CPT 24538
|
| Hospital Charge Code |
900501694
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.46 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$1,805.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| 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 |
$5,398.00
|
| Rate for Payer: Cash Price |
$4,964.30
|
| Rate for Payer: Cash Price |
$4,964.30
|
| Rate for Payer: Cash Price |
$4,964.30
|
| Rate for Payer: Cigna of CA HMO |
$5,776.64
|
| Rate for Payer: Cigna of CA PPO |
$6,679.24
|
| 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 |
$7,672.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,415.60
|
| 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 |
$6,020.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$801.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,166.24
|
| 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 |
$7,220.80
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$5,866.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,672.10
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,415.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,513.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,513.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,513.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,513.00
|
| 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 PERCUTANEOUS TUBE DRN CATH CHANGE
|
Facility
|
IP
|
$1,851.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
909001855
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$370.20 |
| Max. Negotiated Rate |
$1,573.35 |
| Rate for Payer: Adventist Health Commercial |
$370.20
|
| Rate for Payer: Cash Price |
$1,018.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.24
|
| Rate for Payer: Multiplan Commercial |
$1,480.80
|
| Rate for Payer: Networks By Design Commercial |
$1,203.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
|
|
HC PERCUTANEOUS TUBE DRN CATH CHANGE
|
Facility
|
OP
|
$1,851.00
|
|
|
Service Code
|
CPT 75984
|
| Hospital Charge Code |
909001855
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.79 |
| Max. Negotiated Rate |
$1,573.35 |
| Rate for Payer: Adventist Health Commercial |
$370.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,214.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,018.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,388.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,132.81
|
| Rate for Payer: Blue Shield of California EPN |
$747.80
|
| Rate for Payer: Cash Price |
$1,018.05
|
| Rate for Payer: Cash Price |
$1,018.05
|
| Rate for Payer: Cigna of CA HMO |
$1,184.64
|
| Rate for Payer: Cigna of CA PPO |
$1,369.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,573.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,573.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.40
|
| Rate for Payer: EPIC Health Plan Senior |
$740.40
|
| Rate for Payer: Galaxy Health WC |
$1,573.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,110.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$113.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,234.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$128.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,145.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,295.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,295.70
|
| Rate for Payer: Multiplan Commercial |
$1,480.80
|
| Rate for Payer: Networks By Design Commercial |
$1,203.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,573.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,110.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,110.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$925.50
|
| Rate for Payer: United Healthcare All Other HMO |
$925.50
|
| Rate for Payer: United Healthcare HMO Rider |
$925.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$925.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,573.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,573.35
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
OP
|
$14,171.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$425.95 |
| Max. Negotiated Rate |
$12,045.35 |
| Rate for Payer: Adventist Health Commercial |
$2,834.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| 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 |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,672.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,725.08
|
| Rate for Payer: Cash Price |
$7,794.05
|
| Rate for Payer: Cash Price |
$7,794.05
|
| Rate for Payer: Cash Price |
$7,794.05
|
| Rate for Payer: Cigna of CA HMO |
$9,069.44
|
| Rate for Payer: Cigna of CA PPO |
$10,486.54
|
| 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 |
$12,045.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,502.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$425.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,452.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,401.04
|
| 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 |
$11,336.80
|
| Rate for Payer: Networks By Design Commercial |
$9,211.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,045.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,502.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,502.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,085.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,085.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,085.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,085.50
|
| 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 PERCUT RETRIEVAL F B
|
Facility
|
IP
|
$14,171.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,834.20 |
| Max. Negotiated Rate |
$12,045.35 |
| Rate for Payer: Adventist Health Commercial |
$2,834.20
|
| Rate for Payer: Cash Price |
$7,794.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,668.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,668.40
|
| Rate for Payer: Galaxy Health WC |
$12,045.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,502.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,452.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,399.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,771.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,401.04
|
| Rate for Payer: Multiplan Commercial |
$11,336.80
|
| Rate for Payer: Networks By Design Commercial |
$9,211.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,045.35
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
OP
|
$12,735.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.76 |
| Max. Negotiated Rate |
$10,824.75 |
| Rate for Payer: Adventist Health Commercial |
$2,547.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$7,004.25
|
| Rate for Payer: Cash Price |
$7,004.25
|
| Rate for Payer: Cash Price |
$7,004.25
|
| Rate for Payer: Cigna of CA HMO |
$8,150.40
|
| Rate for Payer: Cigna of CA PPO |
$9,423.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$10,824.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,641.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$10,188.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$8,277.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,824.75
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,641.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,367.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,367.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,367.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,367.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
IP
|
$12,735.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,547.00 |
| Max. Negotiated Rate |
$10,824.75 |
| Rate for Payer: Adventist Health Commercial |
$2,547.00
|
| Rate for Payer: Cash Price |
$7,004.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,094.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,094.00
|
| Rate for Payer: Galaxy Health WC |
$10,824.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,641.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,494.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,852.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,882.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.40
|
| Rate for Payer: Multiplan Commercial |
$10,188.00
|
| Rate for Payer: Networks By Design Commercial |
$8,277.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,824.75
|
|
|
HC PERICARDIOCENTESIS
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.40 |
| Max. Negotiated Rate |
$728.45 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$562.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$728.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$471.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.28
|
| Rate for Payer: Blue Shield of California Commercial |
$524.48
|
| Rate for Payer: Blue Shield of California EPN |
$346.23
|
| Rate for Payer: Cash Price |
$471.35
|
| Rate for Payer: Cigna of CA HMO |
$548.48
|
| Rate for Payer: Cigna of CA PPO |
$634.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$728.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$728.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$728.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.80
|
| Rate for Payer: EPIC Health Plan Senior |
$342.80
|
| Rate for Payer: Galaxy Health WC |
$728.45
|
| Rate for Payer: Global Benefits Group Commercial |
$514.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$571.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$530.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$599.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$599.90
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: Networks By Design Commercial |
$557.05
|
| Rate for Payer: Prime Health Services Commercial |
$728.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$514.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$428.50
|
| Rate for Payer: United Healthcare All Other HMO |
$428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$428.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$428.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$728.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$728.45
|
| Rate for Payer: Vantage Medical Group Senior |
$728.45
|
|
|
HC PERICARDIOCENTESIS
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.40 |
| Max. Negotiated Rate |
$728.45 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Cash Price |
$471.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.80
|
| Rate for Payer: EPIC Health Plan Senior |
$342.80
|
| Rate for Payer: Galaxy Health WC |
$728.45
|
| Rate for Payer: Global Benefits Group Commercial |
$514.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$571.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$326.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$530.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.68
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: Networks By Design Commercial |
$557.05
|
| Rate for Payer: Prime Health Services Commercial |
$728.45
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$279.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,187.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,047.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$857.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$768.35
|
| Rate for Payer: Cash Price |
$768.35
|
| Rate for Payer: Cigna of CA HMO |
$894.08
|
| Rate for Payer: Cigna of CA PPO |
$1,033.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,187.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,187.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,187.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.80
|
| Rate for Payer: EPIC Health Plan Senior |
$558.80
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$977.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$977.90
|
| Rate for Payer: Multiplan Commercial |
$1,117.60
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$838.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$698.50
|
| Rate for Payer: United Healthcare All Other HMO |
$698.50
|
| Rate for Payer: United Healthcare HMO Rider |
$698.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$698.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,187.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,187.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,187.45
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
909000125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$986.24
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$883.30
|
| Rate for Payer: Cash Price |
$883.30
|
| Rate for Payer: Cigna of CA HMO |
$1,027.84
|
| Rate for Payer: Cigna of CA PPO |
$1,188.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,365.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,365.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,124.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,124.20
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$803.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$803.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.40 |
| Max. Negotiated Rate |
$1,187.45 |
| Rate for Payer: Adventist Health Commercial |
$279.40
|
| Rate for Payer: Cash Price |
$768.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.80
|
| Rate for Payer: EPIC Health Plan Senior |
$558.80
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$931.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.28
|
| Rate for Payer: Multiplan Commercial |
$1,117.60
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
909000125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,365.10 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Cash Price |
$883.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: EPIC Health Plan Senior |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$611.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$994.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
909000126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$249.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,059.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$685.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$935.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$765.78
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$685.85
|
| Rate for Payer: Cash Price |
$685.85
|
| Rate for Payer: Cigna of CA HMO |
$798.08
|
| Rate for Payer: Cigna of CA PPO |
$922.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,059.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,059.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,059.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$498.80
|
| Rate for Payer: Galaxy Health WC |
$1,059.95
|
| Rate for Payer: Global Benefits Group Commercial |
$748.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$872.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$872.90
|
| Rate for Payer: Multiplan Commercial |
$997.60
|
| Rate for Payer: Networks By Design Commercial |
$810.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$748.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.50
|
| Rate for Payer: United Healthcare All Other HMO |
$623.50
|
| Rate for Payer: United Healthcare HMO Rider |
$623.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,059.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,059.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,059.95
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$217.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$922.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$666.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: Cigna of CA HMO |
$694.40
|
| Rate for Payer: Cigna of CA PPO |
$802.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$922.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$922.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$922.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.00
|
| Rate for Payer: EPIC Health Plan Senior |
$434.00
|
| Rate for Payer: Galaxy Health WC |
$922.25
|
| Rate for Payer: Global Benefits Group Commercial |
$651.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$723.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$671.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$759.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$759.50
|
| Rate for Payer: Multiplan Commercial |
$868.00
|
| Rate for Payer: Networks By Design Commercial |
$705.25
|
| Rate for Payer: Prime Health Services Commercial |
$922.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.50
|
| Rate for Payer: United Healthcare All Other HMO |
$542.50
|
| Rate for Payer: United Healthcare HMO Rider |
$542.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$922.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$922.25
|
| Rate for Payer: Vantage Medical Group Senior |
$922.25
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
IP
|
$1,247.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
909000126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.40 |
| Max. Negotiated Rate |
$1,059.95 |
| Rate for Payer: Adventist Health Commercial |
$249.40
|
| Rate for Payer: Cash Price |
$685.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$498.80
|
| Rate for Payer: Galaxy Health WC |
$1,059.95
|
| Rate for Payer: Global Benefits Group Commercial |
$748.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$831.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$475.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$771.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.28
|
| Rate for Payer: Multiplan Commercial |
$997.60
|
| Rate for Payer: Networks By Design Commercial |
$810.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.95
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: Adventist Health Commercial |
$217.00
|
| Rate for Payer: Cash Price |
$596.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.00
|
| Rate for Payer: EPIC Health Plan Senior |
$434.00
|
| Rate for Payer: Galaxy Health WC |
$922.25
|
| Rate for Payer: Global Benefits Group Commercial |
$651.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$723.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$671.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.40
|
| Rate for Payer: Multiplan Commercial |
$868.00
|
| Rate for Payer: Networks By Design Commercial |
$705.25
|
| Rate for Payer: Prime Health Services Commercial |
$922.25
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$4,775.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
906820267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$955.00 |
| Max. Negotiated Rate |
$4,058.75 |
| Rate for Payer: Adventist Health Commercial |
$955.00
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,910.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,910.00
|
| Rate for Payer: Galaxy Health WC |
$4,058.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,865.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,184.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,819.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,955.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,146.00
|
| Rate for Payer: Multiplan Commercial |
$3,820.00
|
| Rate for Payer: Networks By Design Commercial |
$3,103.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,058.75
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$4,912.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$337.13 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$982.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,701.60
|
| Rate for Payer: Cash Price |
$2,701.60
|
| Rate for Payer: Cash Price |
$2,701.60
|
| Rate for Payer: Cigna of CA HMO |
$3,143.68
|
| Rate for Payer: Cigna of CA PPO |
$3,634.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,175.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,947.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$337.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,276.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,192.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,175.20
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,947.20
|
| 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 |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$4,775.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
906820267
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$337.13 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$955.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Cash Price |
$2,626.25
|
| Rate for Payer: Cigna of CA HMO |
$3,056.00
|
| Rate for Payer: Cigna of CA PPO |
$3,533.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,058.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,865.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$337.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,184.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$381.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,146.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,486.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,820.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,103.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,058.75
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,865.00
|
| 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 |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$4,912.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$982.40 |
| Max. Negotiated Rate |
$4,175.20 |
| Rate for Payer: Adventist Health Commercial |
$982.40
|
| Rate for Payer: Cash Price |
$2,701.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.80
|
| Rate for Payer: Galaxy Health WC |
$4,175.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,947.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,276.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,871.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,040.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.88
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: Networks By Design Commercial |
$3,192.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,175.20
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.00 |
| Max. Negotiated Rate |
$538.90 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$415.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.73
|
| Rate for Payer: Blue Shield of California Commercial |
$424.15
|
| Rate for Payer: Blue Shield of California EPN |
$280.23
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$380.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$538.90 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$348.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$253.60
|
| Rate for Payer: EPIC Health Plan Senior |
$253.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$422.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$241.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.16
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
|
