|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$843.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$929.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
905352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$1,215.50 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$865.58
|
| Rate for Payer: Blue Shield of California Commercial |
$725.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,099.67
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$518.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$843.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
|
HC PELVIC SLING
|
Facility
|
OP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$343.20 |
| Max. Negotiated Rate |
$1,215.50 |
| Rate for Payer: Adventist Health Commercial |
$586.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$786.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,072.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$865.58
|
| Rate for Payer: Blue Shield of California Commercial |
$725.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1,099.67
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,215.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,215.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$518.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$586.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$843.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,001.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,001.00
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$715.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$858.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$858.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,215.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,215.50
|
|
|
HC PELVIC SLING
|
Facility
|
IP
|
$1,430.00
|
|
|
Service Code
|
CPT L2580
|
| Hospital Charge Code |
915352580
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$286.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$286.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cash Price |
$643.50
|
| Rate for Payer: Cigna of CA HMO |
$1,001.00
|
| Rate for Payer: Cigna of CA PPO |
$1,001.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,001.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$572.00
|
| Rate for Payer: Galaxy Health WC |
$1,215.50
|
| Rate for Payer: Global Benefits Group Commercial |
$858.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$908.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$843.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.20
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Networks By Design Commercial |
$929.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,215.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.68
|
| Rate for Payer: United Healthcare All Other HMO |
$522.38
|
| Rate for Payer: United Healthcare HMO Rider |
$511.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$468.32
|
|
|
HC PELVIMMETRY
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
|
|
HC PELVIMMETRY
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
909001915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.69
|
| Rate for Payer: Blue Shield of California Commercial |
$330.48
|
| Rate for Payer: Blue Shield of California Commercial |
$218.08
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$440.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$440.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$305.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$362.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$362.60
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$440.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.30
|
| Rate for Payer: Vantage Medical Group Senior |
$440.30
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.32 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.13
|
| Rate for Payer: Blue Shield of California Commercial |
$271.97
|
| Rate for Payer: Blue Shield of California Commercial |
$412.15
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna of CA HMO |
$413.44
|
| Rate for Payer: Cigna of CA PPO |
$478.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC PELVIS 1 OR 2 VIEWS
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
909001339
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$452.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.40
|
| Rate for Payer: EPIC Health Plan Senior |
$258.40
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$410.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$381.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.04
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$206.80 |
| Max. Negotiated Rate |
$878.90 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.60
|
| Rate for Payer: EPIC Health Plan Senior |
$413.60
|
| Rate for Payer: Galaxy Health WC |
$878.90
|
| Rate for Payer: Global Benefits Group Commercial |
$620.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$656.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.16
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: Networks By Design Commercial |
$672.10
|
| Rate for Payer: Prime Health Services Commercial |
$878.90
|
|
|
HC PELVIS COMPLETE MIN 3 VIEWS
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
909001342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$878.90 |
| Rate for Payer: Adventist Health Commercial |
$206.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$221.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$197.90
|
| Rate for Payer: Blue Shield of California Commercial |
$435.31
|
| Rate for Payer: Blue Shield of California Commercial |
$659.69
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cash Price |
$465.30
|
| Rate for Payer: Cigna of CA HMO |
$661.76
|
| Rate for Payer: Cigna of CA PPO |
$765.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$723.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$878.90
|
| Rate for Payer: Global Benefits Group Commercial |
$620.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$656.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$827.20
|
| Rate for Payer: Networks By Design Commercial |
$672.10
|
| Rate for Payer: Prime Health Services Commercial |
$878.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$620.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$620.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC PEN A 1 (SHRIMP), IGE
|
Facility
|
OP
|
$16.29
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
900913751
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$3.26 |
| Max. Negotiated Rate |
$170.73 |
| Rate for Payer: Adventist Health Commercial |
$3.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$130.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.73
|
| Rate for Payer: Blue Shield of California Commercial |
$11.35
|
| Rate for Payer: Blue Shield of California Commercial |
$7.51
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cash Price |
$7.33
|
| Rate for Payer: Cigna of CA HMO |
$10.43
|
| Rate for Payer: Cigna of CA PPO |
$12.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Senior |
$19.72
|
| Rate for Payer: Galaxy Health WC |
$13.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9.77
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.03
|
| Rate for Payer: Multiplan Commercial |
$13.03
|
| Rate for Payer: Networks By Design Commercial |
$10.59
|
| Rate for Payer: Prime Health Services Commercial |
$13.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.53
|
| Rate for Payer: United Healthcare All Other HMO |
$14.53
|
| Rate for Payer: United Healthcare HMO Rider |
$14.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.72
|
| Rate for Payer: Vantage Medical Group Senior |
$17.93
|
|
|
HC PENILE INJECTION
|
Facility
|
OP
|
$1,725.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$321.35 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Cigna of CA HMO |
$1,104.00
|
| Rate for Payer: Cigna of CA PPO |
$1,276.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,207.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,095.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$626.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$404.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,121.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$862.50
|
| Rate for Payer: United Healthcare All Other HMO |
$862.50
|
| Rate for Payer: United Healthcare HMO Rider |
$862.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC PENILE INJECTION
|
Facility
|
IP
|
$1,725.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
900501609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$1,466.25 |
| Rate for Payer: Adventist Health Commercial |
$345.00
|
| Rate for Payer: Cash Price |
$776.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,207.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$690.00
|
| Rate for Payer: EPIC Health Plan Senior |
$690.00
|
| Rate for Payer: Galaxy Health WC |
$1,466.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,035.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,095.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,017.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: Networks By Design Commercial |
$1,121.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,466.25
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
OP
|
$1,691.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$134.46 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Adventist Health Commercial |
$338.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$833.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,085.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,078.86
|
| Rate for Payer: Blue Shield of California Commercial |
$711.91
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Cigna of CA HMO |
$1,082.24
|
| Rate for Payer: Cigna of CA PPO |
$1,251.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,183.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$1,437.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,073.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$314.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$169.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Networks By Design Commercial |
$1,099.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,437.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,014.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,289.00
|
| Rate for Payer: United Healthcare HMO Rider |
$978.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC PENILE VASC STUDIES COMPLETE
|
Facility
|
IP
|
$1,691.00
|
|
|
Service Code
|
CPT 93980
|
| Hospital Charge Code |
908100111
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$338.20 |
| Max. Negotiated Rate |
$1,437.35 |
| Rate for Payer: Adventist Health Commercial |
$338.20
|
| Rate for Payer: Cash Price |
$760.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,183.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.40
|
| Rate for Payer: EPIC Health Plan Senior |
$676.40
|
| Rate for Payer: Galaxy Health WC |
$1,437.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,073.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$997.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.84
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Networks By Design Commercial |
$1,099.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,437.35
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
IP
|
$14,091.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,818.20 |
| Max. Negotiated Rate |
$11,977.35 |
| Rate for Payer: Adventist Health Commercial |
$2,818.20
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,863.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,636.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,636.40
|
| Rate for Payer: Galaxy Health WC |
$11,977.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,454.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,947.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,313.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,381.84
|
| Rate for Payer: Multiplan Commercial |
$11,272.80
|
| Rate for Payer: Networks By Design Commercial |
$9,159.15
|
| Rate for Payer: Prime Health Services Commercial |
$11,977.35
|
|
|
HC PERC BILIARY DRAINAGE EXT
|
Facility
|
OP
|
$14,091.00
|
|
|
Service Code
|
CPT 47533
|
| Hospital Charge Code |
909000145
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,059.02 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,818.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Cash Price |
$6,340.95
|
| Rate for Payer: Cigna of CA HMO |
$9,018.24
|
| Rate for Payer: Cigna of CA PPO |
$10,427.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,863.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| Rate for Payer: Galaxy Health WC |
$11,977.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,454.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,059.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,947.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,328.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,446.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,381.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,802.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$11,272.80
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$9,159.15
|
| Rate for Payer: Prime Health Services Commercial |
$11,977.35
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,454.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,045.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
OP
|
$13,877.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,533.14 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,775.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,942.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,454.70
|
| Rate for Payer: Cash Price |
$6,244.65
|
| Rate for Payer: Cash Price |
$6,244.65
|
| Rate for Payer: Cash Price |
$6,244.65
|
| Rate for Payer: Cigna of CA HMO |
$8,881.28
|
| Rate for Payer: Cigna of CA PPO |
$10,268.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,713.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| Rate for Payer: Galaxy Health WC |
$11,795.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,326.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,533.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,811.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,864.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,446.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,330.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,802.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$11,101.60
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$9,020.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,795.45
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,326.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,938.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC PERC BILIARY DRAIN INT & EX
|
Facility
|
IP
|
$13,877.00
|
|
|
Service Code
|
CPT 47534
|
| Hospital Charge Code |
909000146
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,775.40 |
| Max. Negotiated Rate |
$11,795.45 |
| Rate for Payer: Adventist Health Commercial |
$2,775.40
|
| Rate for Payer: Cash Price |
$6,244.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,713.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,550.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,550.80
|
| Rate for Payer: Galaxy Health WC |
$11,795.45
|
| Rate for Payer: Global Benefits Group Commercial |
$8,326.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,811.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,187.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,330.48
|
| Rate for Payer: Multiplan Commercial |
$11,101.60
|
| Rate for Payer: Networks By Design Commercial |
$9,020.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,795.45
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$7,942.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,497.37 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,588.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$3,573.90
|
| Rate for Payer: Cash Price |
$3,573.90
|
| Rate for Payer: Cash Price |
$3,573.90
|
| Rate for Payer: Cigna of CA HMO |
$5,082.88
|
| Rate for Payer: Cigna of CA PPO |
$5,877.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,559.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$6,750.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,765.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,497.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,043.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,693.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$6,353.60
|
| Rate for Payer: Multiplan WC |
$2,387.03
|
| Rate for Payer: Networks By Design Commercial |
$5,162.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,750.70
|
| Rate for Payer: Prime Health Services WC |
$2,362.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,765.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,971.00
|
| 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 |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC PERC CECOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$7,942.00
|
|
|
Service Code
|
CPT 49442
|
| Hospital Charge Code |
909000215
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,588.40 |
| Max. Negotiated Rate |
$6,750.70 |
| Rate for Payer: Adventist Health Commercial |
$1,588.40
|
| Rate for Payer: Cash Price |
$3,573.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,559.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,176.80
|
| Rate for Payer: Galaxy Health WC |
$6,750.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,765.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,043.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,685.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,906.08
|
| Rate for Payer: Multiplan Commercial |
$6,353.60
|
| Rate for Payer: Networks By Design Commercial |
$5,162.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,750.70
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
OP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.59 |
| Max. Negotiated Rate |
$2,754.00 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,754.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,324.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,545.21
|
| Rate for Payer: Blue Shield of California Commercial |
$1,536.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,013.77
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Cigna of CA HMO |
$1,541.12
|
| Rate for Payer: Cigna of CA PPO |
$1,781.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,046.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,046.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$175.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,529.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$198.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,420.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,685.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,685.60
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,444.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,444.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,204.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,204.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,204.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,204.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,046.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,046.80
|
|
|
HC PERC DRAINAGE W CATH PLACEMENT
|
Facility
|
IP
|
$2,408.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
906601707
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$2,046.80 |
| Rate for Payer: Adventist Health Commercial |
$481.60
|
| Rate for Payer: Cash Price |
$1,083.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,685.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$963.20
|
| Rate for Payer: EPIC Health Plan Senior |
$963.20
|
| Rate for Payer: Galaxy Health WC |
$2,046.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,444.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,529.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,420.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.92
|
| Rate for Payer: Multiplan Commercial |
$1,926.40
|
| Rate for Payer: Networks By Design Commercial |
$1,565.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,046.80
|
|
|
HC PERC HC TRANSCATH ABLTN PULM ARTERIES RH CATH
|
Facility
|
OP
|
$47,609.00
|
|
|
Service Code
|
CPT 0793T
|
| Hospital Charge Code |
906819786
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$40,467.65 |
| Rate for Payer: Adventist Health Commercial |
$9,521.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30,550.70
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$21,424.05
|
| Rate for Payer: Cash Price |
$21,424.05
|
| Rate for Payer: Cash Price |
$21,424.05
|
| Rate for Payer: Cigna of CA HMO |
$30,469.76
|
| Rate for Payer: Cigna of CA PPO |
$35,230.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,326.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$40,467.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,565.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,231.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,282.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,426.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29,707.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$38,087.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$30,945.85
|
| Rate for Payer: Prime Health Services Commercial |
$40,467.65
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,565.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,804.50
|
| Rate for Payer: United Healthcare All Other HMO |
$23,804.50
|
| Rate for Payer: United Healthcare HMO Rider |
$23,804.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23,804.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC PERC HC TRANSCATH ABLTN PULM ARTERIES RH CATH
|
Facility
|
IP
|
$47,609.00
|
|
|
Service Code
|
CPT 0793T
|
| Hospital Charge Code |
906819786
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,521.80 |
| Max. Negotiated Rate |
$40,467.65 |
| Rate for Payer: Adventist Health Commercial |
$9,521.80
|
| Rate for Payer: Cash Price |
$21,424.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,326.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,043.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,043.60
|
| Rate for Payer: Galaxy Health WC |
$40,467.65
|
| Rate for Payer: Global Benefits Group Commercial |
$28,565.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,231.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,089.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,426.16
|
| Rate for Payer: Multiplan Commercial |
$38,087.20
|
| Rate for Payer: Networks By Design Commercial |
$30,945.85
|
| Rate for Payer: Prime Health Services Commercial |
$40,467.65
|
|
