|
HC PERCUT RETRIEVAL F B
|
Facility
|
OP
|
$14,171.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$425.95 |
| Max. Negotiated Rate |
$12,045.35 |
| Rate for Payer: Adventist Health Commercial |
$2,834.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,951.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,041.10
|
| Rate for Payer: Blue Shield of California Commercial |
$5,965.99
|
| Rate for Payer: Cash Price |
$6,376.95
|
| Rate for Payer: Cash Price |
$6,376.95
|
| Rate for Payer: Cash Price |
$6,376.95
|
| Rate for Payer: Cigna of CA HMO |
$9,069.44
|
| Rate for Payer: Cigna of CA PPO |
$10,486.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,919.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$12,045.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,502.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$425.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,998.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$481.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,401.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$11,336.80
|
| Rate for Payer: Networks By Design Commercial |
$9,211.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,045.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,502.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,502.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,085.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,085.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,085.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,085.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC PERCUT RETRIEVAL F B
|
Facility
|
IP
|
$14,171.00
|
|
|
Service Code
|
CPT 37197
|
| Hospital Charge Code |
909020163
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,834.20 |
| Max. Negotiated Rate |
$12,045.35 |
| Rate for Payer: Adventist Health Commercial |
$2,834.20
|
| Rate for Payer: Cash Price |
$6,376.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,919.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,668.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,668.40
|
| Rate for Payer: Galaxy Health WC |
$12,045.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,502.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,998.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,360.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,401.04
|
| Rate for Payer: Multiplan Commercial |
$11,336.80
|
| Rate for Payer: Networks By Design Commercial |
$9,211.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,045.35
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
OP
|
$12,735.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.76 |
| Max. Negotiated Rate |
$10,824.75 |
| Rate for Payer: Adventist Health Commercial |
$2,547.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Cash Price |
$5,730.75
|
| Rate for Payer: Cash Price |
$5,730.75
|
| Rate for Payer: Cash Price |
$5,730.75
|
| Rate for Payer: Cigna of CA HMO |
$8,150.40
|
| Rate for Payer: Cigna of CA PPO |
$9,423.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,914.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$10,824.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,641.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,086.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$244.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$10,188.00
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$8,277.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,824.75
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,641.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,367.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,367.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,367.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,367.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
|
HC PERCUT TREAT MALAR FX W/MANIPU
|
Facility
|
IP
|
$12,735.00
|
|
|
Service Code
|
CPT 21355
|
| Hospital Charge Code |
900501424
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,547.00 |
| Max. Negotiated Rate |
$10,824.75 |
| Rate for Payer: Adventist Health Commercial |
$2,547.00
|
| Rate for Payer: Cash Price |
$5,730.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,914.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,094.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,094.00
|
| Rate for Payer: Galaxy Health WC |
$10,824.75
|
| Rate for Payer: Global Benefits Group Commercial |
$7,641.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,086.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,513.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,056.40
|
| Rate for Payer: Multiplan Commercial |
$10,188.00
|
| Rate for Payer: Networks By Design Commercial |
$8,277.75
|
| Rate for Payer: Prime Health Services Commercial |
$10,824.75
|
|
|
HC PERICARDIOCENTESIS
|
Facility
|
OP
|
$857.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.40 |
| Max. Negotiated Rate |
$728.45 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$562.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$728.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$471.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$642.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.12
|
| Rate for Payer: Blue Shield of California Commercial |
$360.80
|
| Rate for Payer: Blue Shield of California Commercial |
$546.77
|
| Rate for Payer: Cash Price |
$385.65
|
| Rate for Payer: Cash Price |
$385.65
|
| Rate for Payer: Cigna of CA HMO |
$548.48
|
| Rate for Payer: Cigna of CA PPO |
$634.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$728.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$728.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$728.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.80
|
| Rate for Payer: EPIC Health Plan Senior |
$342.80
|
| Rate for Payer: Galaxy Health WC |
$728.45
|
| Rate for Payer: Global Benefits Group Commercial |
$514.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$599.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$599.90
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: Networks By Design Commercial |
$557.05
|
| Rate for Payer: Prime Health Services Commercial |
$728.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$514.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$514.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$428.50
|
| Rate for Payer: United Healthcare All Other HMO |
$428.50
|
| Rate for Payer: United Healthcare HMO Rider |
$428.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$428.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$728.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$728.45
|
| Rate for Payer: Vantage Medical Group Senior |
$728.45
|
|
|
HC PERICARDIOCENTESIS
|
Facility
|
IP
|
$857.00
|
|
|
Service Code
|
CPT 76930
|
| Hospital Charge Code |
909001449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.40 |
| Max. Negotiated Rate |
$728.45 |
| Rate for Payer: Adventist Health Commercial |
$171.40
|
| Rate for Payer: Cash Price |
$385.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$599.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.80
|
| Rate for Payer: EPIC Health Plan Senior |
$342.80
|
| Rate for Payer: Galaxy Health WC |
$728.45
|
| Rate for Payer: Global Benefits Group Commercial |
$514.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$544.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$505.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.68
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: Networks By Design Commercial |
$557.05
|
| Rate for Payer: Prime Health Services Commercial |
$728.45
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,397.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.40 |
| Max. Negotiated Rate |
$1,187.45 |
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Adventist Health Commercial |
$279.40
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$977.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.80
|
| Rate for Payer: EPIC Health Plan Senior |
$558.80
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$887.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$824.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.28
|
| Rate for Payer: Multiplan Commercial |
$1,117.60
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
909000125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,365.10 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,124.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,019.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$947.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,397.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
900501128
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$279.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$279.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,187.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,047.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$896.45
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cash Price |
$628.65
|
| Rate for Payer: Cigna of CA HMO |
$894.08
|
| Rate for Payer: Cigna of CA PPO |
$1,033.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,187.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,187.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,187.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$977.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$558.80
|
| Rate for Payer: EPIC Health Plan Senior |
$558.80
|
| Rate for Payer: Galaxy Health WC |
$1,187.45
|
| Rate for Payer: Global Benefits Group Commercial |
$838.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$887.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$507.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$824.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$335.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$977.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$977.90
|
| Rate for Payer: Multiplan Commercial |
$1,117.60
|
| Rate for Payer: Networks By Design Commercial |
$908.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,187.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$838.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$698.50
|
| Rate for Payer: United Healthcare All Other HMO |
$698.50
|
| Rate for Payer: United Healthcare HMO Rider |
$698.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$698.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,187.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,187.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,187.45
|
|
|
HC PERICARDIOCENTESIS INITIAL
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 33010
|
| Hospital Charge Code |
909000125
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,030.57
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,124.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,019.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$582.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$947.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$385.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,124.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,124.20
|
| Rate for Payer: Multiplan Commercial |
$1,284.80
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$803.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$803.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
OP
|
$1,085.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$217.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$922.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$596.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$696.24
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$488.25
|
| Rate for Payer: Cash Price |
$488.25
|
| Rate for Payer: Cigna of CA HMO |
$694.40
|
| Rate for Payer: Cigna of CA PPO |
$802.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$922.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$922.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$922.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.00
|
| Rate for Payer: EPIC Health Plan Senior |
$434.00
|
| Rate for Payer: Galaxy Health WC |
$922.25
|
| Rate for Payer: Global Benefits Group Commercial |
$651.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$688.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$393.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$759.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$759.50
|
| Rate for Payer: Multiplan Commercial |
$868.00
|
| Rate for Payer: Networks By Design Commercial |
$705.25
|
| Rate for Payer: Prime Health Services Commercial |
$922.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.50
|
| Rate for Payer: United Healthcare All Other HMO |
$542.50
|
| Rate for Payer: United Healthcare HMO Rider |
$542.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$922.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$922.25
|
| Rate for Payer: Vantage Medical Group Senior |
$922.25
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
OP
|
$1,247.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
909000126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$249.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,059.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$685.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$935.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$800.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$561.15
|
| Rate for Payer: Cash Price |
$561.15
|
| Rate for Payer: Cigna of CA HMO |
$798.08
|
| Rate for Payer: Cigna of CA PPO |
$922.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,059.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,059.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,059.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$872.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$498.80
|
| Rate for Payer: Galaxy Health WC |
$1,059.95
|
| Rate for Payer: Global Benefits Group Commercial |
$748.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$791.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$735.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$872.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$872.90
|
| Rate for Payer: Multiplan Commercial |
$997.60
|
| Rate for Payer: Networks By Design Commercial |
$810.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$748.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.50
|
| Rate for Payer: United Healthcare All Other HMO |
$623.50
|
| Rate for Payer: United Healthcare HMO Rider |
$623.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,059.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,059.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,059.95
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
IP
|
$1,085.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
900501518
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.00 |
| Max. Negotiated Rate |
$922.25 |
| Rate for Payer: Adventist Health Commercial |
$217.00
|
| Rate for Payer: Cash Price |
$488.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.00
|
| Rate for Payer: EPIC Health Plan Senior |
$434.00
|
| Rate for Payer: Galaxy Health WC |
$922.25
|
| Rate for Payer: Global Benefits Group Commercial |
$651.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$688.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$640.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$260.40
|
| Rate for Payer: Multiplan Commercial |
$868.00
|
| Rate for Payer: Networks By Design Commercial |
$705.25
|
| Rate for Payer: Prime Health Services Commercial |
$922.25
|
|
|
HC PERICARDIOCENTESIS SUBSEQNT
|
Facility
|
IP
|
$1,247.00
|
|
|
Service Code
|
CPT 33011
|
| Hospital Charge Code |
909000126
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$249.40 |
| Max. Negotiated Rate |
$1,059.95 |
| Rate for Payer: Adventist Health Commercial |
$249.40
|
| Rate for Payer: Cash Price |
$561.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$872.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$498.80
|
| Rate for Payer: Galaxy Health WC |
$1,059.95
|
| Rate for Payer: Global Benefits Group Commercial |
$748.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$791.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$735.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$299.28
|
| Rate for Payer: Multiplan Commercial |
$997.60
|
| Rate for Payer: Networks By Design Commercial |
$810.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,059.95
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
IP
|
$4,912.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$982.40 |
| Max. Negotiated Rate |
$4,175.20 |
| Rate for Payer: Adventist Health Commercial |
$982.40
|
| Rate for Payer: Cash Price |
$2,210.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,438.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,964.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,964.80
|
| Rate for Payer: Galaxy Health WC |
$4,175.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,947.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,119.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,898.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.88
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: Networks By Design Commercial |
$3,192.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,175.20
|
|
|
HC PERICARDIOCENTESIS W/IMAGING
|
Facility
|
OP
|
$4,912.00
|
|
|
Service Code
|
CPT 33016
|
| Hospital Charge Code |
900503016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$337.13 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$982.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,210.40
|
| Rate for Payer: Cash Price |
$2,210.40
|
| Rate for Payer: Cash Price |
$2,210.40
|
| Rate for Payer: Cigna of CA HMO |
$3,143.68
|
| Rate for Payer: Cigna of CA PPO |
$3,634.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,438.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$4,175.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,947.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$337.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,119.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$381.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,178.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,192.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,175.20
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,947.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,456.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$476.64 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.02
|
| Rate for Payer: Blue Shield of California Commercial |
$292.27
|
| Rate for Payer: Blue Shield of California Commercial |
$62.70
|
| Rate for Payer: Blue Shield of California Commercial |
$441.90
|
| Rate for Payer: Blue Shield of California Commercial |
$94.79
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| 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 Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
|
|
HC PERIOD ACID SCHIFF
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
903800258
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$27.20 |
| Max. Negotiated Rate |
$476.64 |
| Rate for Payer: Adventist Health Commercial |
$27.20
|
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$476.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.02
|
| Rate for Payer: Blue Shield of California Commercial |
$292.27
|
| Rate for Payer: Blue Shield of California Commercial |
$62.70
|
| Rate for Payer: Blue Shield of California Commercial |
$441.90
|
| Rate for Payer: Blue Shield of California Commercial |
$94.79
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna of CA HMO |
$405.76
|
| Rate for Payer: Cigna of CA HMO |
$87.04
|
| Rate for Payer: Cigna of CA PPO |
$100.64
|
| Rate for Payer: Cigna of CA PPO |
$469.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$538.90
|
| Rate for Payer: Global Benefits Group Commercial |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$380.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$57.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$507.20
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Networks By Design Commercial |
$412.10
|
| Rate for Payer: Networks By Design Commercial |
$88.40
|
| Rate for Payer: Prime Health Services Commercial |
$115.60
|
| Rate for Payer: Prime Health Services Commercial |
$538.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$380.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.60
|
| 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 Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
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 |
$285.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| 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
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 88313
|
| Hospital Charge Code |
900910051
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$126.80 |
| Max. Negotiated Rate |
$538.90 |
| Rate for Payer: Adventist Health Commercial |
$126.80
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$443.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$402.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$374.06
|
| 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 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 |
$98.18
|
| Rate for Payer: Cash Price |
$68.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$55.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| 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 |
$68.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| 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 |
$51.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| 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 |
$73.80
|
| Rate for Payer: Cash Price |
$51.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$80.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$73.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.85
|
| 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
|
$485.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.68 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cash Price |
$218.25
|
| Rate for Payer: Cash Price |
$218.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$339.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$307.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.15
|
| 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 |
$242.50
|
| 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
|
|
