|
HC REMOVE FOREIGN BODY (RENAL)
|
Facility
|
IP
|
$6,765.00
|
|
|
Service Code
|
CPT 50561
|
| Hospital Charge Code |
909081362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$5,750.25 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,735.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,706.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,706.00
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,295.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,991.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
|
OP
|
$6,765.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$838.74 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,896.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Cigna of CA HMO |
$4,329.60
|
| Rate for Payer: Cigna of CA PPO |
$5,006.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,585.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,896.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,735.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,378.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7,585.79
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,309.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$838.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,896.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,295.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$948.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,654.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,689.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,240.87
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Multiplan WC |
$10,291.67
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
| Rate for Payer: Prime Health Services WC |
$10,186.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,059.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,382.50
|
| 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 |
$6,896.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,344.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,585.79
|
| Rate for Payer: Vantage Medical Group Senior |
$6,896.17
|
|
|
HC REMOVE FOREIGN BODY (URETER
|
Facility
|
IP
|
$6,765.00
|
|
|
Service Code
|
CPT 50961
|
| Hospital Charge Code |
909081363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,353.00 |
| Max. Negotiated Rate |
$5,750.25 |
| Rate for Payer: Adventist Health Commercial |
$1,353.00
|
| Rate for Payer: Cash Price |
$3,044.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,735.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,706.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,706.00
|
| Rate for Payer: Galaxy Health WC |
$5,750.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,059.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,295.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,991.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,623.60
|
| Rate for Payer: Multiplan Commercial |
$5,412.00
|
| Rate for Payer: Networks By Design Commercial |
$4,397.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,750.25
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$383.40
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| Rate for Payer: Cash Price |
$862.65
|
| 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 |
$1,749.80
|
| 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 |
$1,341.90
|
| 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 |
$1,629.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,150.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,142.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,217.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,291.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.08
|
| 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 |
$1,533.60
|
| 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 |
$958.50
|
| 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 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 |
$862.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,341.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,217.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,131.03
|
| 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
|
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 |
$1,401.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,179.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,977.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,837.26
|
| 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 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 |
$1,032.68
|
| 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 |
$540.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,986.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,310.99
|
| Rate for Payer: Cash Price |
$1,401.30
|
| Rate for Payer: Cash Price |
$1,401.30
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,179.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,977.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,837.26
|
| 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 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 |
$5,251.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,169.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7,410.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,885.30
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,334.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$5,251.50
|
| Rate for Payer: Cash Price |
$5,251.50
|
| Rate for Payer: Cash Price |
$5,251.50
|
| 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 |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,169.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$9,919.50
|
| Rate for Payer: Global Benefits Group Commercial |
$7,002.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$528.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,410.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$597.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,800.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,116.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$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 |
$5,835.00
|
| 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 |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$292.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$658.35
|
| Rate for Payer: Cash Price |
$658.35
|
| Rate for Payer: Cash Price |
$658.35
|
| 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 |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,024.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.79
|
| Rate for Payer: EPIC Health Plan Senior |
$986.52
|
| 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/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$763.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$929.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$863.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$351.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,130.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.77
|
| 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 |
$731.50
|
| 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: Upland Medical Group Pediatric |
$896.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
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 |
$658.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,024.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$929.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$863.17
|
| 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 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 |
$2,561.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,985.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,615.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,358.87
|
| 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 |
$2,561.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,985.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,615.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,358.87
|
| 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 |
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 |
$2,561.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,985.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,615.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,358.87
|
| 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 |
909080021
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,138.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,561.85
|
| Rate for Payer: Cash Price |
$2,561.85
|
| Rate for Payer: Cash Price |
$2,561.85
|
| 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 |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,985.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| 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/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,615.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,138.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,561.85
|
| Rate for Payer: Cash Price |
$2,561.85
|
| Rate for Payer: Cash Price |
$2,561.85
|
| 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 |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,985.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| 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/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$228.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,615.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$1,138.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,561.85
|
| Rate for Payer: Cash Price |
$2,561.85
|
| Rate for Payer: Cash Price |
$2,561.85
|
| 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 |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,985.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| 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/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,615.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$258.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$867.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,366.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
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 |
$1,264.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,967.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,784.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,657.90
|
| 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$562.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| 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 |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,967.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| 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/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$256.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,784.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$290.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,016.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,081.14
|
| 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 |
$1,405.00
|
| 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 |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,010.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,574.78
|
| Rate for Payer: Blue Shield of California Commercial |
$3,897.87
|
| Rate for Payer: Cash Price |
$4,523.40
|
| Rate for Payer: Cash Price |
$4,523.40
|
| Rate for Payer: Cash Price |
$4,523.40
|
| 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 |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,036.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| 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/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,213.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,383.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,503.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,412.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| 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 |
$5,026.00
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
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 |
$4,523.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,036.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6,383.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,930.68
|
| 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 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 |
$9,323.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,472.51
|
| Rate for Payer: Blue Shield of California Commercial |
$5,596.61
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Cash Price |
$3,341.70
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,198.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,715.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$315.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,381.34
|
| 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 |
$3,713.00
|
| 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
|
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: EPIC Health Plan Senior |
$2,970.40
|
| Rate for Payer: Adventist Health Commercial |
$1,485.20
|
| Rate for Payer: Cash Price |
$3,341.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,198.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Foundation Hospitals Commercial/Self Funded |
$4,715.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,381.34
|
| 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
|
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 |
$2,263.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,520.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3,193.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,967.11
|
| 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 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 |
$7,035.98 |
| Rate for Payer: Adventist Health Commercial |
$1,005.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,264.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$2,263.05
|
| Rate for Payer: Cash Price |
$2,263.05
|
| Rate for Payer: Cash Price |
$2,263.05
|
| 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 |
$6,396.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,690.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,264.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,520.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,035.98
|
| Rate for Payer: EPIC Health Plan Senior |
$4,690.65
|
| Rate for Payer: Galaxy Health WC |
$4,274.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,017.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,993.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,264.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,193.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,584.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,206.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,372.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,714.07
|
| Rate for Payer: Multiplan Commercial |
$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 |
$4,264.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,396.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,690.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,264.23
|
|
