|
HC PERITONEOGRAM
|
Facility
|
IP
|
$485.00
|
|
|
Service Code
|
CPT 49400
|
| Hospital Charge Code |
909000190
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$97.00 |
| Max. Negotiated Rate |
$412.25 |
| Rate for Payer: Adventist Health Commercial |
$97.00
|
| Rate for Payer: Cash Price |
$218.25
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$307.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$286.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.40
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: Networks By Design Commercial |
$315.25
|
| Rate for Payer: Prime Health Services Commercial |
$412.25
|
|
|
HC PERITONEOGRAM
|
Facility
|
IP
|
$1,296.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.20 |
| Max. Negotiated Rate |
$1,101.60 |
| Rate for Payer: Adventist Health Commercial |
$259.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.40
|
| Rate for Payer: EPIC Health Plan Senior |
$518.40
|
| Rate for Payer: Galaxy Health WC |
$1,101.60
|
| Rate for Payer: Global Benefits Group Commercial |
$777.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$822.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$764.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.04
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: Networks By Design Commercial |
$842.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,101.60
|
|
|
HC PERITONEOGRAM
|
Facility
|
OP
|
$1,296.00
|
|
|
Service Code
|
CPT 74190
|
| Hospital Charge Code |
909001474
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$58.01 |
| Max. Negotiated Rate |
$1,657.33 |
| Rate for Payer: Adventist Health Commercial |
$259.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,657.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$702.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.75
|
| Rate for Payer: Blue Shield of California Commercial |
$545.62
|
| Rate for Payer: Blue Shield of California Commercial |
$826.85
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cash Price |
$583.20
|
| Rate for Payer: Cigna of CA HMO |
$829.44
|
| Rate for Payer: Cigna of CA PPO |
$959.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$773.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$907.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,159.59
|
| Rate for Payer: EPIC Health Plan Senior |
$773.06
|
| Rate for Payer: Galaxy Health WC |
$1,101.60
|
| Rate for Payer: Global Benefits Group Commercial |
$777.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,152.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$58.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$702.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$822.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$983.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$311.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.73
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: Networks By Design Commercial |
$842.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,101.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$777.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$777.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$605.23
|
| Rate for Payer: United Healthcare All Other HMO |
$605.23
|
| Rate for Payer: United Healthcare HMO Rider |
$605.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$702.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,054.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$773.06
|
| Rate for Payer: Vantage Medical Group Senior |
$702.78
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
IP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna of CA HMO |
$781.20
|
| Rate for Payer: Cigna of CA PPO |
$781.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$781.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$708.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$658.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: Networks By Design Commercial |
$558.00
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.83
|
| Rate for Payer: United Healthcare All Other HMO |
$407.67
|
| Rate for Payer: United Healthcare HMO Rider |
$398.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$365.49
|
|
|
HC PERM DIALYSIS CATH
|
Facility
|
OP
|
$1,116.00
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
909081101
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.20 |
| Max. Negotiated Rate |
$948.60 |
| Rate for Payer: Adventist Health Commercial |
$223.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$613.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$837.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$675.51
|
| Rate for Payer: Blue Shield of California Commercial |
$565.81
|
| Rate for Payer: Blue Shield of California Commercial |
$858.20
|
| Rate for Payer: Cash Price |
$502.20
|
| Rate for Payer: Cigna of CA HMO |
$781.20
|
| Rate for Payer: Cigna of CA PPO |
$781.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$948.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$948.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$948.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$781.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.40
|
| Rate for Payer: EPIC Health Plan Senior |
$446.40
|
| Rate for Payer: Galaxy Health WC |
$948.60
|
| Rate for Payer: Global Benefits Group Commercial |
$669.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$708.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$405.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$658.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$267.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$781.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$781.20
|
| Rate for Payer: Multiplan Commercial |
$892.80
|
| Rate for Payer: Networks By Design Commercial |
$558.00
|
| Rate for Payer: Prime Health Services Commercial |
$948.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$418.83
|
| Rate for Payer: United Healthcare All Other HMO |
$407.67
|
| Rate for Payer: United Healthcare HMO Rider |
$398.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$365.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$948.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$948.60
|
| Rate for Payer: Vantage Medical Group Senior |
$948.60
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
915350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
915350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: Adventist Health Commercial |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.71
|
| Rate for Payer: Blue Shield of California Commercial |
$45.37
|
| Rate for Payer: Blue Shield of California Commercial |
$29.91
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50.15
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
905350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.06 |
| Max. Negotiated Rate |
$50.15 |
| Rate for Payer: Adventist Health Commercial |
$24.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.71
|
| Rate for Payer: Blue Shield of California Commercial |
$45.37
|
| Rate for Payer: Blue Shield of California Commercial |
$29.91
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$29.50
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.15
|
| Rate for Payer: Vantage Medical Group Senior |
$50.15
|
|
|
HC PERONEAL STRAPS, PAIR
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT L0980
|
| Hospital Charge Code |
905350980
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cash Price |
$26.55
|
| Rate for Payer: Cigna of CA HMO |
$41.30
|
| Rate for Payer: Cigna of CA PPO |
$41.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.60
|
| Rate for Payer: EPIC Health Plan Senior |
$23.60
|
| Rate for Payer: Galaxy Health WC |
$50.15
|
| Rate for Payer: Global Benefits Group Commercial |
$35.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.16
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Networks By Design Commercial |
$38.35
|
| Rate for Payer: Prime Health Services Commercial |
$50.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.14
|
| Rate for Payer: United Healthcare All Other HMO |
$21.55
|
| Rate for Payer: United Healthcare HMO Rider |
$21.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.32
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$391.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,166.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,255.17
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Cigna of CA HMO |
$1,251.84
|
| Rate for Payer: Cigna of CA PPO |
$1,447.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,283.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,166.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,369.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,924.77
|
| Rate for Payer: EPIC Health Plan Senior |
$1,283.18
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,242.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,469.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,173.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$978.00
|
| 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 |
$1,166.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,749.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,283.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,166.53
|
|
|
HC PER ORAL ENDO MYOTOMY POEM
|
Facility
|
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 43499
|
| Hospital Charge Code |
906763499
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$391.20 |
| Max. Negotiated Rate |
$1,662.60 |
| Rate for Payer: Adventist Health Commercial |
$391.20
|
| Rate for Payer: Cash Price |
$880.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,369.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$782.40
|
| Rate for Payer: EPIC Health Plan Senior |
$782.40
|
| Rate for Payer: Galaxy Health WC |
$1,662.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,173.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,242.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,154.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$469.44
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: Networks By Design Commercial |
$1,271.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,662.60
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.01 |
| Max. Negotiated Rate |
$1,709.80 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$863.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$863.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.01
|
| Rate for Payer: Blue Shield of California Commercial |
$176.56
|
| Rate for Payer: Blue Shield of California Commercial |
$486.82
|
| Rate for Payer: Blue Shield of California Commercial |
$266.95
|
| Rate for Payer: Blue Shield of California Commercial |
$736.03
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$245.12
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Cigna of CA PPO |
$283.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
|
|
HC PEROXIDASE STAIN
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910037
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
OP
|
$48,949.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,574.78 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,789.80
|
| 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 |
$16,261.00
|
| 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 |
$22,027.05
|
| Rate for Payer: Cash Price |
$22,027.05
|
| Rate for Payer: Cash Price |
$22,027.05
|
| Rate for Payer: Cigna of CA HMO |
$31,327.36
|
| Rate for Payer: Cigna of CA PPO |
$36,222.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$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 |
$34,264.30
|
| 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 |
$41,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29,369.40
|
| 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 |
$31,082.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,747.76
|
| 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 |
$39,159.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,816.85
|
| Rate for Payer: Prime Health Services Commercial |
$41,606.65
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,369.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,474.50
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 PERQ AV FIST UE SEP ACCESS PRPHL ARTERY AND VEIN
|
Facility
|
IP
|
$48,949.00
|
|
|
Service Code
|
CPT 36837
|
| Hospital Charge Code |
906816837
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,789.80 |
| Max. Negotiated Rate |
$41,606.65 |
| Rate for Payer: Adventist Health Commercial |
$9,789.80
|
| Rate for Payer: Cash Price |
$22,027.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,264.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,579.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,579.60
|
| Rate for Payer: Galaxy Health WC |
$41,606.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29,369.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31,082.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,879.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,747.76
|
| Rate for Payer: Multiplan Commercial |
$39,159.20
|
| Rate for Payer: Networks By Design Commercial |
$31,816.85
|
| Rate for Payer: Prime Health Services Commercial |
$41,606.65
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$8,240.00 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$883.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,204.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Cash Price |
$722.70
|
| 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: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,019.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.12
|
| 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 |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,365.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,365.10
|
|
|
HC PERQ PRCRD DRG INS CATH CT GDN
|
Facility
|
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 33019
|
| Hospital Charge Code |
900503019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,365.10 |
| Rate for Payer: Adventist Health Commercial |
$321.20
|
| Rate for Payer: Cash Price |
$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 PERQ STEN/CHEST VERT ART
|
Facility
|
OP
|
$33,569.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,374.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,713.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28,533.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,462.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,176.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$15,106.05
|
| Rate for Payer: Cash Price |
$15,106.05
|
| Rate for Payer: Cigna of CA HMO |
$21,484.16
|
| Rate for Payer: Cigna of CA PPO |
$24,841.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28,533.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$28,533.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,533.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,498.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13,427.60
|
| Rate for Payer: Galaxy Health WC |
$28,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$20,141.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,316.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,185.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,805.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,056.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,498.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23,498.30
|
| Rate for Payer: Multiplan Commercial |
$26,855.20
|
| Rate for Payer: Networks By Design Commercial |
$21,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$28,533.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,141.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,784.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28,533.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28,533.65
|
| Rate for Payer: Vantage Medical Group Senior |
$28,533.65
|
|
|
HC PERQ STEN/CHEST VERT ART
|
Facility
|
IP
|
$33,569.00
|
|
|
Service Code
|
CPT 0075T
|
| Hospital Charge Code |
909081390
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$6,713.80 |
| Max. Negotiated Rate |
$28,533.65 |
| Rate for Payer: Adventist Health Commercial |
$6,713.80
|
| Rate for Payer: Cash Price |
$15,106.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,498.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13,427.60
|
| Rate for Payer: Galaxy Health WC |
$28,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$20,141.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,316.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19,805.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,056.56
|
| Rate for Payer: Multiplan Commercial |
$26,855.20
|
| Rate for Payer: Networks By Design Commercial |
$21,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$28,533.65
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
IP
|
$47,234.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,446.80 |
| Max. Negotiated Rate |
$40,148.90 |
| Rate for Payer: Adventist Health Commercial |
$9,446.80
|
| Rate for Payer: Cash Price |
$21,255.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,063.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,893.60
|
| Rate for Payer: EPIC Health Plan Senior |
$18,893.60
|
| Rate for Payer: Galaxy Health WC |
$40,148.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,340.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29,993.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27,868.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,336.16
|
| Rate for Payer: Multiplan Commercial |
$37,787.20
|
| Rate for Payer: Networks By Design Commercial |
$30,702.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,148.90
|
|
|
HC PERQ TRANSCATH CLOSURE PDA
|
Facility
|
OP
|
$47,234.00
|
|
|
Service Code
|
CPT 93582
|
| Hospital Charge Code |
906811455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$949.65 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$9,446.80
|
| 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 |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$21,255.30
|
| Rate for Payer: Cash Price |
$21,255.30
|
| Rate for Payer: Cash Price |
$21,255.30
|
| Rate for Payer: Cigna of CA HMO |
$30,702.10
|
| Rate for Payer: Cigna of CA PPO |
$34,953.16
|
| 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 |
$33,063.80
|
| 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 |
$40,148.90
|
| Rate for Payer: Global Benefits Group Commercial |
$28,340.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$949.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29,993.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,074.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,336.16
|
| 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 |
$37,787.20
|
| Rate for Payer: Networks By Design Commercial |
$30,702.10
|
| Rate for Payer: Prime Health Services Commercial |
$40,148.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,340.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28,340.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,617.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| 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 PERQ TRANSCATH CLS AORTIC
|
Facility
|
IP
|
$48,598.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,719.60 |
| Max. Negotiated Rate |
$41,308.30 |
| Rate for Payer: Multiplan Commercial |
$38,878.40
|
| Rate for Payer: Adventist Health Commercial |
$9,719.60
|
| Rate for Payer: Cash Price |
$21,869.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34,018.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,439.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19,439.20
|
| Rate for Payer: Galaxy Health WC |
$41,308.30
|
| Rate for Payer: Global Benefits Group Commercial |
$29,158.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,859.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,672.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,663.52
|
| Rate for Payer: Networks By Design Commercial |
$31,588.70
|
| Rate for Payer: Prime Health Services Commercial |
$41,308.30
|
|
|
HC PERQ TRANSCATH CLS AORTIC
|
Facility
|
OP
|
$48,598.00
|
|
|
Service Code
|
CPT 93591
|
| Hospital Charge Code |
900093591
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,403.00 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$9,719.60
|
| 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 |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$21,869.10
|
| Rate for Payer: Cash Price |
$21,869.10
|
| Rate for Payer: Cash Price |
$21,869.10
|
| Rate for Payer: Cigna of CA HMO |
$31,588.70
|
| Rate for Payer: Cigna of CA PPO |
$35,962.52
|
| 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 |
$34,018.60
|
| 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 |
$41,308.30
|
| Rate for Payer: Global Benefits Group Commercial |
$29,158.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,403.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,859.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,586.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,663.52
|
| 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 |
$38,878.40
|
| Rate for Payer: Networks By Design Commercial |
$31,588.70
|
| Rate for Payer: Prime Health Services Commercial |
$41,308.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,158.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29,158.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| 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 PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
IP
|
$38,079.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,615.80 |
| Max. Negotiated Rate |
$32,367.15 |
| Rate for Payer: Adventist Health Commercial |
$7,615.80
|
| Rate for Payer: Cash Price |
$17,135.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26,655.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,231.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15,231.60
|
| Rate for Payer: Galaxy Health WC |
$32,367.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,847.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,180.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22,466.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,138.96
|
| Rate for Payer: Multiplan Commercial |
$30,463.20
|
| Rate for Payer: Networks By Design Commercial |
$24,751.35
|
| Rate for Payer: Prime Health Services Commercial |
$32,367.15
|
|
|
HC PERQ TRANSCATH CLSRE MITRAL
|
Facility
|
OP
|
$38,079.00
|
|
|
Service Code
|
CPT 93590
|
| Hospital Charge Code |
906811590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,690.13 |
| Max. Negotiated Rate |
$71,375.00 |
| Rate for Payer: Adventist Health Commercial |
$7,615.80
|
| 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 |
$9,759.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$17,135.55
|
| Rate for Payer: Cash Price |
$17,135.55
|
| Rate for Payer: Cash Price |
$17,135.55
|
| Rate for Payer: Cigna of CA HMO |
$24,751.35
|
| Rate for Payer: Cigna of CA PPO |
$28,178.46
|
| 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 |
$26,655.30
|
| 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 |
$32,367.15
|
| Rate for Payer: Global Benefits Group Commercial |
$22,847.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,690.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24,180.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,911.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9,138.96
|
| 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 |
$30,463.20
|
| Rate for Payer: Networks By Design Commercial |
$24,751.35
|
| Rate for Payer: Prime Health Services Commercial |
$32,367.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22,847.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22,847.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19,039.50
|
| Rate for Payer: United Healthcare All Other HMO |
$71,375.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57,385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52,575.00
|
| 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
|
|
