|
HC REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,191.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: Cigna of CA HMO |
$1,226.88
|
| Rate for Payer: Cigna of CA PPO |
$1,418.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,310.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,191.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,608.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,191.26
|
| Rate for Payer: Galaxy Health WC |
$1,629.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,150.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,953.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,142.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,191.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,278.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,191.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,500.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,596.29
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$1,246.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,629.45
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,150.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,191.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,786.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,310.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1,191.26
|
|
|
HC REMOVE OBSTRUCT GAST/JEJ/CEC T
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
909020008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$383.40 |
| Max. Negotiated Rate |
$1,629.45 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| Rate for Payer: Cash Price |
$1,054.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.80
|
| Rate for Payer: EPIC Health Plan Senior |
$766.80
|
| Rate for Payer: Galaxy Health WC |
$1,629.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,150.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,278.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$730.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,186.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.08
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: Networks By Design Commercial |
$1,246.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,629.45
|
|
|
HC REMOVE PERICATH OBSTRUCTION
|
Facility
|
OP
|
$3,114.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$2,646.90 |
| Rate for Payer: Adventist Health Commercial |
$622.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,042.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,646.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,712.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,335.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.75
|
| Rate for Payer: Blue Shield of California Commercial |
$1,905.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,258.06
|
| Rate for Payer: Cash Price |
$1,712.70
|
| Rate for Payer: Cash Price |
$1,712.70
|
| Rate for Payer: Cigna of CA HMO |
$1,992.96
|
| Rate for Payer: Cigna of CA PPO |
$2,304.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,646.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,646.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,646.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,245.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,245.60
|
| Rate for Payer: Galaxy Health WC |
$2,646.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,868.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,077.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,927.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,179.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,179.80
|
| Rate for Payer: Multiplan Commercial |
$2,491.20
|
| Rate for Payer: Networks By Design Commercial |
$2,024.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,646.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,868.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,868.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,557.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,557.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,557.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,557.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,646.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,646.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,646.90
|
|
|
HC REMOVE PERICATH OBSTRUCTION
|
Facility
|
IP
|
$3,114.00
|
|
|
Service Code
|
CPT 75901
|
| Hospital Charge Code |
909020013
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$622.80 |
| Max. Negotiated Rate |
$2,646.90 |
| Rate for Payer: Adventist Health Commercial |
$622.80
|
| Rate for Payer: Cash Price |
$1,712.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,245.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,245.60
|
| Rate for Payer: Galaxy Health WC |
$2,646.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,868.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,077.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,186.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,927.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$747.36
|
| Rate for Payer: Multiplan Commercial |
$2,491.20
|
| Rate for Payer: Networks By Design Commercial |
$2,024.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,646.90
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
IP
|
$11,670.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,334.00 |
| Max. Negotiated Rate |
$9,919.50 |
| Rate for Payer: Adventist Health Commercial |
$2,334.00
|
| Rate for Payer: Cash Price |
$6,418.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,668.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4,668.00
|
| Rate for Payer: Galaxy Health WC |
$9,919.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,002.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,783.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,446.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,223.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,800.80
|
| Rate for Payer: Multiplan Commercial |
$9,336.00
|
| Rate for Payer: Networks By Design Commercial |
$7,585.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,919.50
|
|
|
HC REMOVE PERM CANNULA/CATHETER
|
Facility
|
OP
|
$11,670.00
|
|
|
Service Code
|
CPT 49422
|
| Hospital Charge Code |
909001458
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$528.51 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,334.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$6,418.50
|
| Rate for Payer: Cash Price |
$6,418.50
|
| Rate for Payer: Cash Price |
$6,418.50
|
| Rate for Payer: Cigna of CA HMO |
$7,468.80
|
| Rate for Payer: Cigna of CA PPO |
$8,635.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$9,919.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,002.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$528.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,783.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$597.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,800.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$9,336.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$7,585.50
|
| Rate for Payer: Prime Health Services Commercial |
$9,919.50
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,002.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
|
IP
|
$1,463.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.60 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Cash Price |
$804.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$585.20
|
| Rate for Payer: EPIC Health Plan Senior |
$585.20
|
| Rate for Payer: Galaxy Health WC |
$1,243.55
|
| Rate for Payer: Global Benefits Group Commercial |
$877.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$975.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$557.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$905.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.12
|
| Rate for Payer: Multiplan Commercial |
$1,170.40
|
| Rate for Payer: Networks By Design Commercial |
$950.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,243.55
|
|
|
HC REMOVE RENAL TUBE W/FLUORO
|
Facility
|
OP
|
$1,463.00
|
|
|
Service Code
|
CPT 50389
|
| Hospital Charge Code |
909081853
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$292.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$804.65
|
| Rate for Payer: Cash Price |
$804.65
|
| Rate for Payer: Cash Price |
$804.65
|
| Rate for Payer: Cigna of CA HMO |
$936.32
|
| Rate for Payer: Cigna of CA PPO |
$1,082.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$1,243.55
|
| Rate for Payer: Global Benefits Group Commercial |
$877.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$763.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$975.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$863.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$1,170.40
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$950.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,243.55
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$5,693.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
909080021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,138.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: Cigna of CA HMO |
$3,643.52
|
| Rate for Payer: Cigna of CA PPO |
$4,212.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$4,839.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,415.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,797.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$4,554.40
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$3,700.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,839.05
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,415.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$5,693.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,138.60 |
| Max. Negotiated Rate |
$4,839.05 |
| Rate for Payer: Adventist Health Commercial |
$1,138.60
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,277.20
|
| Rate for Payer: Galaxy Health WC |
$4,839.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,415.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,797.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,169.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.32
|
| Rate for Payer: Multiplan Commercial |
$4,554.40
|
| Rate for Payer: Networks By Design Commercial |
$3,700.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,839.05
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$5,693.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$258.19 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,138.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: Cigna of CA HMO |
$3,643.52
|
| Rate for Payer: Cigna of CA PPO |
$4,212.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$4,839.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,415.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,797.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$4,554.40
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$3,700.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,839.05
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,415.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,846.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,846.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,846.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,846.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$5,693.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,138.60 |
| Max. Negotiated Rate |
$4,839.05 |
| Rate for Payer: Adventist Health Commercial |
$1,138.60
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,277.20
|
| Rate for Payer: Galaxy Health WC |
$4,839.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,415.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,797.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,169.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.32
|
| Rate for Payer: Multiplan Commercial |
$4,554.40
|
| Rate for Payer: Networks By Design Commercial |
$3,700.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,839.05
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
IP
|
$5,693.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
909080021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,138.60 |
| Max. Negotiated Rate |
$4,839.05 |
| Rate for Payer: Adventist Health Commercial |
$1,138.60
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,277.20
|
| Rate for Payer: Galaxy Health WC |
$4,839.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,415.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,797.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,169.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.32
|
| Rate for Payer: Multiplan Commercial |
$4,554.40
|
| Rate for Payer: Networks By Design Commercial |
$3,700.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,839.05
|
|
|
HC REMOVE TUN CV CATH WO PORT
|
Facility
|
OP
|
$5,693.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
900501636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$1,138.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: Cash Price |
$3,131.15
|
| Rate for Payer: Cigna of CA HMO |
$3,643.52
|
| Rate for Payer: Cigna of CA PPO |
$4,212.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$4,839.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,415.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,797.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$4,554.40
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$3,700.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,839.05
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,415.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REMOVE TUNNEL PLEURAL CATH
|
Facility
|
IP
|
$2,810.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
902100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$562.00 |
| Max. Negotiated Rate |
$2,388.50 |
| Rate for Payer: Adventist Health Commercial |
$562.00
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,124.00
|
| Rate for Payer: Galaxy Health WC |
$2,388.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,686.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,070.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.40
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: Networks By Design Commercial |
$1,826.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,388.50
|
|
|
HC REMOVE TUNNEL PLEURAL CATH
|
Facility
|
OP
|
$2,810.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
902100152
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$256.44 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$562.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna of CA HMO |
$1,798.40
|
| Rate for Payer: Cigna of CA PPO |
$2,079.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$2,388.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,686.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$1,826.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,388.50
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,686.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REMOVE URETER STENT, PERCUT
|
Facility
|
IP
|
$10,052.00
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
909081851
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,010.40 |
| Max. Negotiated Rate |
$8,544.20 |
| Rate for Payer: Adventist Health Commercial |
$2,010.40
|
| Rate for Payer: Cash Price |
$5,528.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,020.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,020.80
|
| Rate for Payer: Galaxy Health WC |
$8,544.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,031.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,704.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,829.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,222.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,412.48
|
| Rate for Payer: Multiplan Commercial |
$8,041.60
|
| Rate for Payer: Networks By Design Commercial |
$6,533.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,544.20
|
|
|
HC REMOVE URETER STENT, PERCUT
|
Facility
|
OP
|
$10,052.00
|
|
|
Service Code
|
CPT 50384
|
| Hospital Charge Code |
909081851
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,010.40 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,010.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$5,528.60
|
| Rate for Payer: Cash Price |
$5,528.60
|
| Rate for Payer: Cash Price |
$5,528.60
|
| Rate for Payer: Cigna of CA HMO |
$6,433.28
|
| Rate for Payer: Cigna of CA PPO |
$7,438.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$8,544.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,031.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,213.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,704.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,503.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,412.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$8,041.60
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$6,533.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,544.20
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,031.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
OP
|
$7,426.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906811430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$278.96 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,084.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,569.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,369.02
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: Cigna of CA HMO |
$4,826.90
|
| Rate for Payer: Cigna of CA PPO |
$5,495.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,312.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,312.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Galaxy Health WC |
$6,312.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,455.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,596.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,198.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,198.20
|
| Rate for Payer: Multiplan Commercial |
$5,940.80
|
| Rate for Payer: Networks By Design Commercial |
$4,826.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,455.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,455.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,312.10
|
| Rate for Payer: Vantage Medical Group Senior |
$6,312.10
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
OP
|
$7,217.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906820233
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$278.96 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,969.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,412.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,369.02
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: Cigna of CA HMO |
$4,691.05
|
| Rate for Payer: Cigna of CA PPO |
$5,340.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,134.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,134.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,886.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,886.80
|
| Rate for Payer: Galaxy Health WC |
$6,134.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,330.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$278.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,467.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,732.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,051.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,051.90
|
| Rate for Payer: Multiplan Commercial |
$5,773.60
|
| Rate for Payer: Networks By Design Commercial |
$4,691.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,134.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,330.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,330.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,134.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,134.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,134.45
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
IP
|
$7,217.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906820233
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,443.40 |
| Max. Negotiated Rate |
$6,134.45 |
| Rate for Payer: Adventist Health Commercial |
$1,443.40
|
| Rate for Payer: Cash Price |
$3,969.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,886.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,886.80
|
| Rate for Payer: Galaxy Health WC |
$6,134.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,330.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,749.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,467.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,732.08
|
| Rate for Payer: Multiplan Commercial |
$5,773.60
|
| Rate for Payer: Networks By Design Commercial |
$4,691.05
|
| Rate for Payer: Prime Health Services Commercial |
$6,134.45
|
|
|
HC REMOVE VAD DIFF SESSION
|
Facility
|
IP
|
$7,426.00
|
|
|
Service Code
|
CPT 33992
|
| Hospital Charge Code |
906811430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,485.20 |
| Max. Negotiated Rate |
$6,312.10 |
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Cash Price |
$4,084.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,970.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Galaxy Health WC |
$6,312.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,455.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,953.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,829.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,596.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,782.24
|
| Rate for Payer: Multiplan Commercial |
$5,940.80
|
| Rate for Payer: Networks By Design Commercial |
$4,826.90
|
| Rate for Payer: Prime Health Services Commercial |
$6,312.10
|
|
|
HC REMOVE VENTILATING TUBE
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
900501512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$120.25 |
| Max. Negotiated Rate |
$6,757.85 |
| Rate for Payer: Adventist Health Commercial |
$1,005.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,120.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,765.95
|
| Rate for Payer: Cash Price |
$2,765.95
|
| Rate for Payer: Cash Price |
$2,765.95
|
| Rate for Payer: Cigna of CA HMO |
$3,218.56
|
| Rate for Payer: Cigna of CA PPO |
$3,721.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,532.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,120.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,562.86
|
| Rate for Payer: EPIC Health Plan Senior |
$4,120.64
|
| Rate for Payer: Galaxy Health WC |
$4,274.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,017.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,757.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,120.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,354.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,120.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,192.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,521.66
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: Multiplan WC |
$6,565.51
|
| Rate for Payer: Networks By Design Commercial |
$3,268.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,274.65
|
| Rate for Payer: Prime Health Services WC |
$6,498.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,017.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,514.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,514.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,514.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,514.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,120.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,180.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,532.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4,120.64
|
|
|
HC REMOVE VENTILATING TUBE
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT 69424
|
| Hospital Charge Code |
900501512
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,005.80 |
| Max. Negotiated Rate |
$4,274.65 |
| Rate for Payer: Adventist Health Commercial |
$1,005.80
|
| Rate for Payer: Cash Price |
$2,765.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,011.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,011.60
|
| Rate for Payer: Galaxy Health WC |
$4,274.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,017.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,354.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,916.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,112.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.96
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: Networks By Design Commercial |
$3,268.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,274.65
|
|
|
HC REMVL TUN CVP ACCESS W SUBCU
|
Facility
|
IP
|
$6,355.00
|
|
|
Service Code
|
CPT 36590
|
| Hospital Charge Code |
909081361
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,271.00 |
| Max. Negotiated Rate |
$5,401.75 |
| Rate for Payer: Adventist Health Commercial |
$1,271.00
|
| Rate for Payer: Cash Price |
$3,495.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,542.00
|
| Rate for Payer: Galaxy Health WC |
$5,401.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,813.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,238.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,421.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,933.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,525.20
|
| Rate for Payer: Multiplan Commercial |
$5,084.00
|
| Rate for Payer: Networks By Design Commercial |
$4,130.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,401.75
|
|
