|
HC PERIOD ACID SCHIFF
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800258
|
|
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
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
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 PERIODIC CHART REVIEW NURSE SPEC
|
Facility
|
OP
|
$153.00
|
|
| Hospital Charge Code |
912154303
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.96
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: Cigna of CA HMO |
$97.92
|
| Rate for Payer: Cigna of CA PPO |
$113.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.10
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.50
|
| Rate for Payer: United Healthcare All Other HMO |
$76.50
|
| Rate for Payer: United Healthcare HMO Rider |
$76.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.05
|
| Rate for Payer: Vantage Medical Group Senior |
$130.05
|
|
|
HC PERIODIC CHART REVIEW NURSE SPEC
|
Facility
|
IP
|
$153.00
|
|
| Hospital Charge Code |
912154303
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$84.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC PERIODIC CHART REV PHYSICIAN
|
Facility
|
IP
|
$115.00
|
|
| Hospital Charge Code |
912174303
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC PERIODIC CHART REV PHYSICIAN
|
Facility
|
OP
|
$115.00
|
|
| Hospital Charge Code |
912174303
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.62
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.50
|
| Rate for Payer: United Healthcare All Other HMO |
$57.50
|
| Rate for Payer: United Healthcare HMO Rider |
$57.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$1,142.54 |
| Rate for Payer: Adventist Health Commercial |
$259.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$850.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$696.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$366.27
|
| Rate for Payer: Blue Shield of California Commercial |
$793.15
|
| Rate for Payer: Blue Shield of California EPN |
$523.58
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: Cigna of CA HMO |
$829.44
|
| Rate for Payer: Cigna of CA PPO |
$959.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$696.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.50
|
| Rate for Payer: EPIC Health Plan Senior |
$696.67
|
| Rate for Payer: Galaxy Health WC |
$1,101.60
|
| Rate for Payer: Global Benefits Group Commercial |
$777.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,142.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$696.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$864.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$696.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$933.54
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: Networks By Design Commercial |
$842.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,101.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$777.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$777.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$696.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,045.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.34
|
| Rate for Payer: Vantage Medical Group Senior |
$696.67
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$1,101.60 |
| Rate for Payer: Adventist Health Commercial |
$259.20
|
| Rate for Payer: Cash Price |
$712.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.40
|
| Rate for Payer: EPIC Health Plan Senior |
$518.40
|
| Rate for Payer: Galaxy Health WC |
$1,101.60
|
| Rate for Payer: Global Benefits Group Commercial |
$777.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$864.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$493.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.04
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: Networks By Design Commercial |
$842.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,101.60
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$485.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$412.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$266.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$363.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$266.75
|
| Rate for Payer: Cash Price |
$266.75
|
| Rate for Payer: Cash Price |
$266.75
|
| Rate for Payer: Cigna of CA HMO |
$310.40
|
| Rate for Payer: Cigna of CA PPO |
$358.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$412.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$412.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Senior |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$339.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$339.50
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$291.00
|
| 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 |
$412.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.25
|
| Rate for Payer: Vantage Medical Group Senior |
$412.25
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Cash Price |
$266.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$194.00
|
| Rate for Payer: EPIC Health Plan Senior |
$194.00
|
| Rate for Payer: Galaxy Health WC |
$412.25
|
| Rate for Payer: Global Benefits Group Commercial |
$291.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$323.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$184.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$300.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna of CA HMO |
$781.20
|
| Rate for Payer: Cigna of CA PPO |
$781.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$690.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: Networks By Design Commercial |
$558.00
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.83
|
| Rate for Payer: United Healthcare All Other HMO |
$407.67
|
| Rate for Payer: United Healthcare HMO Rider |
$398.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$365.49
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$613.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$837.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$646.39
|
| Rate for Payer: Blue Shield of California Commercial |
$823.61
|
| Rate for Payer: Blue Shield of California EPN |
$542.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna of CA HMO |
$781.20
|
| Rate for Payer: Cigna of CA PPO |
$781.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$948.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$948.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$948.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$425.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$690.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$781.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$781.20
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: Networks By Design Commercial |
$558.00
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.83
|
| Rate for Payer: United Healthcare All Other HMO |
$407.67
|
| Rate for Payer: United Healthcare HMO Rider |
$398.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$365.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$948.60
|
| Rate for Payer: Vantage Medical Group Senior |
$948.60
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
915350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: Adventist Health Commercial |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.17
|
| Rate for Payer: Blue Shield of California Commercial |
$43.54
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50.15
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
915350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
905350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: Adventist Health Commercial |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.17
|
| Rate for Payer: Blue Shield of California Commercial |
$43.54
|
| Rate for Payer: Blue Shield of California EPN |
$28.67
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50.15
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
905350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cash Price |
$32.45
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$391.20 |
| Max. Negotiated Rate |
$1,662.60 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Cash Price |
$1,075.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.40
|
| Rate for Payer: EPIC Health Plan Senior |
$782.40
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,304.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$745.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,210.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.44
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$391.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,201.18
|
| 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 |
$1,075.80
|
| Rate for Payer: Cash Price |
$1,075.80
|
| Rate for Payer: Cash Price |
$1,075.80
|
| Rate for Payer: Cigna of CA HMO |
$1,251.84
|
| Rate for Payer: Cigna of CA PPO |
$1,447.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,304.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,429.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$70.82 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$692.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.82
|
| Rate for Payer: Blue Shield of California Commercial |
$706.46
|
| Rate for Payer: Blue Shield of California EPN |
$466.75
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$704.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$653.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
OP
|
$48,949.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,470.08 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,789.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11,370.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$26,921.95
|
| Rate for Payer: Cash Price |
$26,921.95
|
| Rate for Payer: Cash Price |
$26,921.95
|
| Rate for Payer: Cigna of CA HMO |
$31,327.36
|
| Rate for Payer: Cigna of CA PPO |
$36,222.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$41,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29,369.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,648.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,747.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$39,159.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,816.85
|
| Rate for Payer: Prime Health Services Commercial |
$41,606.65
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,369.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
IP
|
$48,949.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,789.80 |
| Max. Negotiated Rate |
$41,606.65 |
| Rate for Payer: Adventist Health Commercial |
$9,789.80
|
| Rate for Payer: Cash Price |
$26,921.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,579.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,579.60
|
| Rate for Payer: Galaxy Health WC |
$41,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29,369.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,648.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,649.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,299.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,747.76
|
| Rate for Payer: Multiplan Commercial |
$39,159.20
|
| Rate for Payer: Networks By Design Commercial |
$31,816.85
|
| Rate for Payer: Prime Health Services Commercial |
$41,606.65
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| 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 PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| 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 |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$883.30
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$367.12
|
| 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 |
$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 |
$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 PERQ STEN/CHEST VERT ART
|
Facility
|
IP
|
$33,569.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,713.80 |
| Max. Negotiated Rate |
$28,533.65 |
| Rate for Payer: Adventist Health Commercial |
$6,713.80
|
| Rate for Payer: Cash Price |
$18,462.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13,427.60
|
| Rate for Payer: Galaxy Health WC |
$28,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$20,141.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,390.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,789.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,779.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,056.56
|
| Rate for Payer: Multiplan Commercial |
$26,855.20
|
| Rate for Payer: Networks By Design Commercial |
$21,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$28,533.65
|
|
