|
HC RETROGRAD URETHROGRAM
|
Facility
|
OP
|
$1,204.00
|
|
|
Service Code
|
CPT 74450
|
| Hospital Charge Code |
909001903
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.75 |
| Max. Negotiated Rate |
$1,023.40 |
| Rate for Payer: Adventist Health Commercial |
$240.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$789.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$410.62
|
| Rate for Payer: Blue Shield of California Commercial |
$736.85
|
| Rate for Payer: Blue Shield of California EPN |
$486.42
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cash Price |
$541.80
|
| Rate for Payer: Cigna of CA HMO |
$770.56
|
| Rate for Payer: Cigna of CA PPO |
$890.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$460.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$337.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$307.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.63
|
| Rate for Payer: EPIC Health Plan Senior |
$307.13
|
| Rate for Payer: Galaxy Health WC |
$1,023.40
|
| Rate for Payer: Global Benefits Group Commercial |
$722.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$503.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$307.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$803.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$307.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$386.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$411.55
|
| Rate for Payer: Multiplan Commercial |
$963.20
|
| Rate for Payer: Networks By Design Commercial |
$782.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,023.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$722.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$722.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$307.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$460.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$337.84
|
| Rate for Payer: Vantage Medical Group Senior |
$307.13
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$667.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$650.27
|
| Rate for Payer: Blue Shield of California Commercial |
$622.40
|
| Rate for Payer: Blue Shield of California EPN |
$410.87
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: Cigna of CA HMO |
$650.88
|
| Rate for Payer: Cigna of CA PPO |
$752.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$571.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$610.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
HC RETRO PYELOGRAM
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 74420
|
| Hospital Charge Code |
909001912
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$203.40 |
| Max. Negotiated Rate |
$864.45 |
| Rate for Payer: Adventist Health Commercial |
$203.40
|
| Rate for Payer: Cash Price |
$457.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$406.80
|
| Rate for Payer: Galaxy Health WC |
$864.45
|
| Rate for Payer: Global Benefits Group Commercial |
$610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$678.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$387.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$629.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$244.08
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Networks By Design Commercial |
$661.05
|
| Rate for Payer: Prime Health Services Commercial |
$864.45
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$92.97 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.35
|
| Rate for Payer: Blue Shield of California Commercial |
$80.72
|
| Rate for Payer: Blue Shield of California EPN |
$53.16
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
IP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
905358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.88 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$21.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
|
|
HC REUSABLE NIPPLE PROSTHESIS
|
Facility
|
OP
|
$109.38
|
|
|
Service Code
|
CPT L8032
|
| Hospital Charge Code |
915358032
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.25 |
| Max. Negotiated Rate |
$92.97 |
| Rate for Payer: Adventist Health Commercial |
$44.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.35
|
| Rate for Payer: Blue Shield of California Commercial |
$80.72
|
| Rate for Payer: Blue Shield of California EPN |
$53.16
|
| Rate for Payer: Cash Price |
$49.22
|
| Rate for Payer: Cigna of CA HMO |
$76.57
|
| Rate for Payer: Cigna of CA PPO |
$76.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$92.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$92.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$92.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$43.75
|
| Rate for Payer: EPIC Health Plan Senior |
$43.75
|
| Rate for Payer: Galaxy Health WC |
$92.97
|
| Rate for Payer: Global Benefits Group Commercial |
$65.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$72.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$76.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$87.50
|
| Rate for Payer: Networks By Design Commercial |
$54.69
|
| Rate for Payer: Prime Health Services Commercial |
$92.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$65.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$65.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.05
|
| Rate for Payer: United Healthcare All Other HMO |
$39.96
|
| Rate for Payer: United Healthcare HMO Rider |
$39.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$92.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$92.97
|
| Rate for Payer: Vantage Medical Group Senior |
$92.97
|
|
|
HC REVERSE MVP MICRO VASC PLUG
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
906812754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,602.30 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,779.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,330.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,178.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,602.56
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: Cigna of CA HMO |
$2,712.32
|
| Rate for Payer: Cigna of CA PPO |
$3,136.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,602.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,602.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,966.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,966.60
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,542.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,542.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,119.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,119.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,119.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,602.30
|
| Rate for Payer: Vantage Medical Group Senior |
$3,602.30
|
|
|
HC REVERSE MVP MICRO VASC PLUG
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
906812754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$847.60 |
| Max. Negotiated Rate |
$3,602.30 |
| Rate for Payer: Adventist Health Commercial |
$847.60
|
| Rate for Payer: Cash Price |
$1,907.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,695.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,695.20
|
| Rate for Payer: Galaxy Health WC |
$3,602.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,542.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,826.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,614.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,623.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,017.12
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: Networks By Design Commercial |
$2,754.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,602.30
|
|
|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
OP
|
$5,927.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,259.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,445.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Cigna of CA HMO |
$3,793.28
|
| Rate for Payer: Cigna of CA PPO |
$4,385.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,037.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,148.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,148.90
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,556.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,556.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,963.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,963.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,963.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,037.95
|
|
|
HC REVISION GASTRODUO WO VAGOTOMY
|
Facility
|
IP
|
$5,927.00
|
|
|
Service Code
|
CPT 43850
|
| Hospital Charge Code |
906743850
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$5,037.95 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
OP
|
$5,927.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,259.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,445.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: Cigna of CA HMO |
$3,793.28
|
| Rate for Payer: Cigna of CA PPO |
$4,385.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,037.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,148.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,148.90
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,556.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,556.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,963.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,963.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,963.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,963.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,037.95
|
| Rate for Payer: Vantage Medical Group Senior |
$5,037.95
|
|
|
HC REVISION GASTRODUO W VAGOTOMY
|
Facility
|
IP
|
$5,927.00
|
|
|
Service Code
|
CPT 43855
|
| Hospital Charge Code |
906743855
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,185.40 |
| Max. Negotiated Rate |
$5,037.95 |
| Rate for Payer: Adventist Health Commercial |
$1,185.40
|
| Rate for Payer: Cash Price |
$2,667.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,370.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,370.80
|
| Rate for Payer: Galaxy Health WC |
$5,037.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,556.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,953.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,258.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,668.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,741.60
|
| Rate for Payer: Networks By Design Commercial |
$3,852.55
|
| Rate for Payer: Prime Health Services Commercial |
$5,037.95
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
OP
|
$35,043.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.68 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$7,008.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30,715.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,244.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,339.00
|
| 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 |
$15,769.35
|
| Rate for Payer: Cash Price |
$15,769.35
|
| Rate for Payer: Cash Price |
$15,769.35
|
| Rate for Payer: Cigna of CA HMO |
$22,427.52
|
| Rate for Payer: Cigna of CA PPO |
$25,931.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,968.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,244.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,779.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7,244.35
|
| Rate for Payer: Galaxy Health WC |
$29,786.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,025.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,880.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,244.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,373.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$474.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,244.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,410.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,127.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,707.43
|
| Rate for Payer: Multiplan Commercial |
$28,034.40
|
| Rate for Payer: Multiplan WC |
$11,542.58
|
| Rate for Payer: Networks By Design Commercial |
$22,777.95
|
| Rate for Payer: Prime Health Services Commercial |
$29,786.55
|
| Rate for Payer: Prime Health Services WC |
$11,424.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,025.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,244.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,866.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,968.78
|
| Rate for Payer: Vantage Medical Group Senior |
$7,244.35
|
|
|
HC REVISION HEPATIC SHUNT (TIPS)
|
Facility
|
IP
|
$35,043.00
|
|
|
Service Code
|
CPT 37183
|
| Hospital Charge Code |
909081384
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,008.60 |
| Max. Negotiated Rate |
$29,786.55 |
| Rate for Payer: Adventist Health Commercial |
$7,008.60
|
| Rate for Payer: Cash Price |
$15,769.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,017.20
|
| Rate for Payer: EPIC Health Plan Senior |
$14,017.20
|
| Rate for Payer: Galaxy Health WC |
$29,786.55
|
| Rate for Payer: Global Benefits Group Commercial |
$21,025.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23,373.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,351.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,691.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,410.32
|
| Rate for Payer: Multiplan Commercial |
$28,034.40
|
| Rate for Payer: Networks By Design Commercial |
$22,777.95
|
| Rate for Payer: Prime Health Services Commercial |
$29,786.55
|
|
|
HC REVISION OF EYELID
|
Facility
|
OP
|
$3,749.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$379.82 |
| Max. Negotiated Rate |
$3,186.65 |
| Rate for Payer: Adventist Health Commercial |
$749.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$379.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: Cigna of CA HMO |
$2,399.36
|
| Rate for Payer: Cigna of CA PPO |
$2,774.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$569.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$417.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$379.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$512.76
|
| Rate for Payer: EPIC Health Plan Senior |
$379.82
|
| Rate for Payer: Galaxy Health WC |
$3,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,249.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$622.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$379.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,500.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$379.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$478.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$508.96
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: Multiplan WC |
$605.18
|
| Rate for Payer: Networks By Design Commercial |
$2,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,186.65
|
| Rate for Payer: Prime Health Services WC |
$599.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,249.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,874.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,874.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,874.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,874.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$379.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$569.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$417.80
|
| Rate for Payer: Vantage Medical Group Senior |
$379.82
|
|
|
HC REVISION OF EYELID
|
Facility
|
IP
|
$3,749.00
|
|
|
Service Code
|
CPT 67999
|
| Hospital Charge Code |
900501485
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$749.80 |
| Max. Negotiated Rate |
$3,186.65 |
| Rate for Payer: Adventist Health Commercial |
$749.80
|
| Rate for Payer: Cash Price |
$1,687.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,499.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,499.60
|
| Rate for Payer: Galaxy Health WC |
$3,186.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,249.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,500.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,428.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,320.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$899.76
|
| Rate for Payer: Multiplan Commercial |
$2,999.20
|
| Rate for Payer: Networks By Design Commercial |
$2,436.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,186.65
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
IP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,696.80 |
| Max. Negotiated Rate |
$41,211.40 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,393.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19,393.60
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,338.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,472.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30,011.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,636.16
|
| Rate for Payer: Multiplan Commercial |
$38,787.20
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
|
|
HC REVSCLRZTN ENDOVASC OPEN OR PERC TIBIAL/PA
|
Facility
|
OP
|
$48,484.00
|
|
|
Service Code
|
CPT C9775
|
| Hospital Charge Code |
906819790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,490.94 |
| Max. Negotiated Rate |
$50,447.00 |
| Rate for Payer: Adventist Health Commercial |
$9,696.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22,815.81
|
| 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 |
$3,490.94
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cash Price |
$21,817.80
|
| Rate for Payer: Cigna of CA HMO |
$31,029.76
|
| Rate for Payer: Cigna of CA PPO |
$35,878.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,097.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,815.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$30,801.34
|
| Rate for Payer: EPIC Health Plan Senior |
$22,815.81
|
| Rate for Payer: Galaxy Health WC |
$41,211.40
|
| Rate for Payer: Global Benefits Group Commercial |
$29,090.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$37,417.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22,815.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32,338.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22,815.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,636.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28,747.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30,573.19
|
| Rate for Payer: Multiplan Commercial |
$38,787.20
|
| Rate for Payer: Multiplan WC |
$36,352.92
|
| Rate for Payer: Networks By Design Commercial |
$31,514.60
|
| Rate for Payer: Prime Health Services Commercial |
$41,211.40
|
| Rate for Payer: Prime Health Services WC |
$35,981.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,090.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$22,815.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34,223.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,097.39
|
| Rate for Payer: Vantage Medical Group Senior |
$22,815.81
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
IP
|
$6,270.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,254.00 |
| Max. Negotiated Rate |
$5,329.50 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,508.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,508.00
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,388.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,881.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
|
|
HC RF ABL NRV NRVTG SJ W/IG
|
Facility
|
OP
|
$6,270.00
|
|
|
Service Code
|
CPT 64625
|
| Hospital Charge Code |
909004625
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$766.82 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$1,254.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,491.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| 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 |
$2,822.94
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cash Price |
$2,821.50
|
| Rate for Payer: Cigna of CA HMO |
$4,012.80
|
| Rate for Payer: Cigna of CA PPO |
$4,639.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$5,329.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,762.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$766.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,182.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$867.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,504.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$5,016.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,075.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,329.50
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,762.00
|
| 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 |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
IP
|
$2,203.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.60 |
| Max. Negotiated Rate |
$1,872.55 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,363.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
|
|
HC RFA CER THOR EA ADD LEVEL
|
Facility
|
OP
|
$2,203.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909064634
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.82 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,211.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,652.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cigna of CA HMO |
$1,409.92
|
| Rate for Payer: Cigna of CA PPO |
$1,630.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,872.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$98.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,363.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,542.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,542.10
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,321.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,872.55
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
OP
|
$2,203.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Dignity Health Medi-Cal |
$1,872.55
|
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,211.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,652.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: Cigna of CA HMO |
$1,409.92
|
| Rate for Payer: Cigna of CA PPO |
$1,630.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,872.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,363.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,542.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,542.10
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,321.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,872.55
|
|
|
HC RFA LUM SAC EA ADD LEVEL
|
Facility
|
IP
|
$2,203.00
|
|
|
Service Code
|
CPT 64636
|
| Hospital Charge Code |
909064636
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$440.60 |
| Max. Negotiated Rate |
$1,872.55 |
| Rate for Payer: Adventist Health Commercial |
$440.60
|
| Rate for Payer: Cash Price |
$991.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$881.20
|
| Rate for Payer: EPIC Health Plan Senior |
$881.20
|
| Rate for Payer: Galaxy Health WC |
$1,872.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,321.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,469.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$839.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,363.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.72
|
| Rate for Payer: Multiplan Commercial |
$1,762.40
|
| Rate for Payer: Networks By Design Commercial |
$1,431.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,872.55
|
|
