|
HC BFLEX 2.8 BRONCHOSCOPE
|
Facility
|
OP
|
$808.00
|
|
| Hospital Charge Code |
900831711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.60 |
| Max. Negotiated Rate |
$727.20 |
| Rate for Payer: Adventist Health Commercial |
$161.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$490.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$444.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$606.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$391.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$470.01
|
| Rate for Payer: Blue Shield of California Commercial |
$512.27
|
| Rate for Payer: Blue Shield of California EPN |
$322.39
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Central Health Plan Commercial |
$646.40
|
| Rate for Payer: Cigna of CA HMO |
$517.12
|
| Rate for Payer: Cigna of CA PPO |
$597.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$686.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$686.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$686.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$565.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$323.20
|
| Rate for Payer: EPIC Health Plan Senior |
$323.20
|
| Rate for Payer: Galaxy Health WC |
$686.80
|
| Rate for Payer: Global Benefits Group Commercial |
$484.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$727.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$513.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$476.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$565.60
|
| Rate for Payer: Multiplan Commercial |
$606.00
|
| Rate for Payer: Networks By Design Commercial |
$525.20
|
| Rate for Payer: Prime Health Services Commercial |
$686.80
|
| Rate for Payer: Riverside University Health System MISP |
$323.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$404.00
|
| Rate for Payer: United Healthcare All Other HMO |
$404.00
|
| Rate for Payer: United Healthcare HMO Rider |
$404.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$404.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$686.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$686.80
|
| Rate for Payer: Vantage Medical Group Senior |
$686.80
|
|
|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BFLEX 3.8 BRONCHOSCOPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
900831703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC BFLEX 5.0 BRONCHOSCOPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
900831701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC BFLEX 5.0 BRONCHOSCOPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
900831701
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC BFLEX 5.8 BRONCHOSCOPE
|
Facility
|
IP
|
$1,564.00
|
|
| Hospital Charge Code |
900831702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,251.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,407.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$922.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.80
|
| Rate for Payer: Multiplan Commercial |
$1,173.00
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
|
|
HC BFLEX 5.8 BRONCHOSCOPE
|
Facility
|
OP
|
$1,564.00
|
|
| Hospital Charge Code |
900831702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.80 |
| Max. Negotiated Rate |
$1,407.60 |
| Rate for Payer: Adventist Health Commercial |
$312.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$949.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,173.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$757.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$909.78
|
| Rate for Payer: Blue Shield of California Commercial |
$991.58
|
| Rate for Payer: Blue Shield of California EPN |
$624.04
|
| Rate for Payer: Cash Price |
$703.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,251.20
|
| Rate for Payer: Cigna of CA HMO |
$1,000.96
|
| Rate for Payer: Cigna of CA PPO |
$1,157.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,329.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,329.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,094.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$625.60
|
| Rate for Payer: EPIC Health Plan Senior |
$625.60
|
| Rate for Payer: Galaxy Health WC |
$1,329.40
|
| Rate for Payer: Global Benefits Group Commercial |
$938.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,407.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$993.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$567.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$922.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$312.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,094.80
|
| Rate for Payer: Multiplan Commercial |
$1,173.00
|
| Rate for Payer: Networks By Design Commercial |
$1,016.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,329.40
|
| Rate for Payer: Riverside University Health System MISP |
$625.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$938.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$938.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$782.00
|
| Rate for Payer: United Healthcare All Other HMO |
$782.00
|
| Rate for Payer: United Healthcare HMO Rider |
$782.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$782.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,329.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,329.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,329.40
|
|
|
HC BG ARTERIAL PUNCTURE
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
900801101
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$209.85
|
| Rate for Payer: Blue Shield of California EPN |
$132.07
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Central Health Plan Commercial |
$264.80
|
| Rate for Payer: Cigna of CA HMO |
$211.84
|
| Rate for Payer: Cigna of CA PPO |
$244.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.50
|
| Rate for Payer: United Healthcare All Other HMO |
$165.50
|
| Rate for Payer: United Healthcare HMO Rider |
$165.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$165.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC BG ARTERIAL PUNCTURE
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 36600
|
| Hospital Charge Code |
900801101
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$297.90 |
| Rate for Payer: Adventist Health Commercial |
$66.20
|
| Rate for Payer: Cash Price |
$148.95
|
| Rate for Payer: Central Health Plan Commercial |
$264.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$231.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.40
|
| Rate for Payer: EPIC Health Plan Senior |
$132.40
|
| Rate for Payer: Galaxy Health WC |
$281.35
|
| Rate for Payer: Global Benefits Group Commercial |
$198.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.20
|
| Rate for Payer: Multiplan Commercial |
$248.25
|
| Rate for Payer: Networks By Design Commercial |
$215.15
|
| Rate for Payer: Prime Health Services Commercial |
$281.35
|
|
|
HC BG IONIZED CALCIUM
|
Facility
|
OP
|
$455.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900801120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.08 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.22
|
| Rate for Payer: Blue Shield of California Commercial |
$286.65
|
| Rate for Payer: Blue Shield of California EPN |
$180.63
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Cigna of CA HMO |
$291.20
|
| Rate for Payer: Cigna of CA PPO |
$336.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$318.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.57
|
| Rate for Payer: EPIC Health Plan Senior |
$15.05
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.33
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.68
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
| Rate for Payer: Prime Health Services Medicare |
$14.50
|
| Rate for Payer: Riverside University Health System MISP |
$15.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$273.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$273.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.08
|
| Rate for Payer: United Healthcare All Other HMO |
$11.08
|
| Rate for Payer: United Healthcare HMO Rider |
$11.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.68
|
|
|
HC BG IONIZED CALCIUM
|
Facility
|
IP
|
$455.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
900801120
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.00 |
| Max. Negotiated Rate |
$409.50 |
| Rate for Payer: Adventist Health Commercial |
$91.00
|
| Rate for Payer: Cash Price |
$204.75
|
| Rate for Payer: Central Health Plan Commercial |
$364.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$318.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.00
|
| Rate for Payer: EPIC Health Plan Senior |
$182.00
|
| Rate for Payer: Galaxy Health WC |
$386.75
|
| Rate for Payer: Global Benefits Group Commercial |
$273.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$409.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$288.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$268.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.00
|
| Rate for Payer: Multiplan Commercial |
$341.25
|
| Rate for Payer: Networks By Design Commercial |
$295.75
|
| Rate for Payer: Prime Health Services Commercial |
$386.75
|
|
|
HC BILATERAL LSHO-CUSTOM FIT ABD
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
CPT L1690
|
| Hospital Charge Code |
905351690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$607.80 |
| Max. Negotiated Rate |
$2,735.10 |
| Rate for Payer: Adventist Health Commercial |
$607.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,437.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,531.66
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,431.20
|
| Rate for Payer: Cigna of CA HMO |
$2,127.30
|
| Rate for Payer: Cigna of CA PPO |
$2,127.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,127.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,735.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,929.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,793.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.80
|
| Rate for Payer: Multiplan Commercial |
$2,279.25
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,140.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,086.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$995.27
|
|
|
HC BILATERAL LSHO-CUSTOM FIT ABD
|
Facility
|
OP
|
$3,039.00
|
|
|
Service Code
|
CPT L1690
|
| Hospital Charge Code |
905351690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$995.27 |
| Max. Negotiated Rate |
$2,735.10 |
| Rate for Payer: Adventist Health Commercial |
$1,245.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,671.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,279.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,767.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,437.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,531.66
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,431.20
|
| Rate for Payer: Cigna of CA HMO |
$2,127.30
|
| Rate for Payer: Cigna of CA PPO |
$2,127.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,583.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,583.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,127.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,735.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,680.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,929.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,856.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,793.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,245.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,127.30
|
| Rate for Payer: Multiplan Commercial |
$2,279.25
|
| Rate for Payer: Networks By Design Commercial |
$1,519.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,215.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,823.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,823.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,140.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,086.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$995.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,583.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,583.15
|
|
|
HC BILATERAL LSHO-CUSTOM FIT ABD
|
Facility
|
IP
|
$3,039.00
|
|
|
Service Code
|
CPT L1690
|
| Hospital Charge Code |
915351690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$607.80 |
| Max. Negotiated Rate |
$2,735.10 |
| Rate for Payer: Adventist Health Commercial |
$607.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,437.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,531.66
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,431.20
|
| Rate for Payer: Cigna of CA HMO |
$2,127.30
|
| Rate for Payer: Cigna of CA PPO |
$2,127.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,127.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,735.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,929.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,793.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.80
|
| Rate for Payer: Multiplan Commercial |
$2,279.25
|
| Rate for Payer: Networks By Design Commercial |
$1,975.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,140.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,086.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$995.27
|
|
|
HC BILATERAL LSHO-CUSTOM FIT ABD
|
Facility
|
OP
|
$3,039.00
|
|
|
Service Code
|
CPT L1690
|
| Hospital Charge Code |
915351690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$995.27 |
| Max. Negotiated Rate |
$2,735.10 |
| Rate for Payer: Adventist Health Commercial |
$1,245.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,671.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,279.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,767.79
|
| Rate for Payer: Blue Shield of California Commercial |
$2,437.28
|
| Rate for Payer: Blue Shield of California EPN |
$1,531.66
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Cash Price |
$1,367.55
|
| Rate for Payer: Central Health Plan Commercial |
$2,431.20
|
| Rate for Payer: Cigna of CA HMO |
$2,127.30
|
| Rate for Payer: Cigna of CA PPO |
$2,127.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,583.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,583.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,127.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,215.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,215.60
|
| Rate for Payer: Galaxy Health WC |
$2,583.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,823.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,735.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,680.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,929.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,856.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,793.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,245.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,127.30
|
| Rate for Payer: Multiplan Commercial |
$2,279.25
|
| Rate for Payer: Networks By Design Commercial |
$1,519.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,583.15
|
| Rate for Payer: Riverside University Health System MISP |
$1,215.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,823.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,823.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,140.54
|
| Rate for Payer: United Healthcare All Other HMO |
$1,110.15
|
| Rate for Payer: United Healthcare HMO Rider |
$1,086.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$995.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,583.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,583.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,583.15
|
|
|
HC BIL CATH CONV EXT TO INT/EXT
|
Facility
|
OP
|
$14,725.00
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
909047535
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,744.97 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,945.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,604.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,604.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$7,144.49
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,780.00
|
| Rate for Payer: Cigna of CA HMO |
$9,424.00
|
| Rate for Payer: Cigna of CA PPO |
$10,896.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,065.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,604.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,307.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,598.23
|
| Rate for Payer: EPIC Health Plan Senior |
$5,065.49
|
| Rate for Payer: Galaxy Health WC |
$12,516.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,835.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,252.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,552.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,744.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,350.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,927.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,446.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,945.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,170.69
|
| Rate for Payer: Multiplan Commercial |
$11,043.75
|
| Rate for Payer: Multiplan WC |
$7,144.49
|
| Rate for Payer: Networks By Design Commercial |
$9,571.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,604.99
|
| Rate for Payer: Preferred Health Network WC |
$7,290.30
|
| Rate for Payer: Prime Health Services Commercial |
$12,516.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,881.29
|
| Rate for Payer: Prime Health Services WC |
$7,071.59
|
| Rate for Payer: Riverside University Health System MISP |
$5,065.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,835.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,362.50
|
| 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 |
$4,604.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,907.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,065.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,604.99
|
|
|
HC BIL CATH CONV EXT TO INT/EXT
|
Facility
|
IP
|
$14,725.00
|
|
|
Service Code
|
CPT 47535
|
| Hospital Charge Code |
909047535
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,945.00 |
| Max. Negotiated Rate |
$13,252.50 |
| Rate for Payer: Adventist Health Commercial |
$2,945.00
|
| Rate for Payer: Cash Price |
$6,626.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,780.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,307.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,890.00
|
| Rate for Payer: Galaxy Health WC |
$12,516.25
|
| Rate for Payer: Global Benefits Group Commercial |
$8,835.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,252.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,350.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,687.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,945.00
|
| Rate for Payer: Multiplan Commercial |
$11,043.75
|
| Rate for Payer: Networks By Design Commercial |
$9,571.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,516.25
|
|
|
HC BILIARY BRUSH/BIOPSY
|
Facility
|
OP
|
$11,361.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
909000148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$416.24 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$2,272.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8,326.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,326.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,632.22
|
| Rate for Payer: Blue Shield of California Commercial |
$5,036.70
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,112.45
|
| Rate for Payer: Cash Price |
$5,112.45
|
| Rate for Payer: Cash Price |
$5,112.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,088.80
|
| Rate for Payer: Cigna of CA HMO |
$7,271.04
|
| Rate for Payer: Cigna of CA PPO |
$8,407.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,159.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,326.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,952.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,738.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9,159.05
|
| Rate for Payer: Galaxy Health WC |
$9,656.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,816.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,224.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13,655.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$416.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,326.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,214.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,656.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,272.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,157.39
|
| Rate for Payer: Multiplan Commercial |
$8,520.75
|
| Rate for Payer: Multiplan WC |
$12,632.22
|
| Rate for Payer: Networks By Design Commercial |
$7,384.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8,326.41
|
| Rate for Payer: Preferred Health Network WC |
$12,890.02
|
| Rate for Payer: Prime Health Services Commercial |
$9,656.85
|
| Rate for Payer: Prime Health Services Medicare |
$8,825.99
|
| Rate for Payer: Prime Health Services WC |
$12,503.32
|
| Rate for Payer: Riverside University Health System MISP |
$9,159.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,816.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,680.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,326.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,489.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,159.05
|
| Rate for Payer: Vantage Medical Group Senior |
$8,326.41
|
|
|
HC BILIARY BRUSH/BIOPSY
|
Facility
|
IP
|
$11,361.00
|
|
|
Service Code
|
CPT 47553
|
| Hospital Charge Code |
909000148
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,272.20 |
| Max. Negotiated Rate |
$10,224.90 |
| Rate for Payer: Adventist Health Commercial |
$2,272.20
|
| Rate for Payer: Cash Price |
$5,112.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,088.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,952.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,544.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,544.40
|
| Rate for Payer: Galaxy Health WC |
$9,656.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,816.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,224.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,214.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,702.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,272.20
|
| Rate for Payer: Multiplan Commercial |
$8,520.75
|
| Rate for Payer: Networks By Design Commercial |
$7,384.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,656.85
|
|
|
HC BILIARY CATH RMVL W FLUORO
|
Facility
|
IP
|
$3,265.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
909047537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$653.00 |
| Max. Negotiated Rate |
$2,938.50 |
| Rate for Payer: Adventist Health Commercial |
$653.00
|
| Rate for Payer: Cash Price |
$1,469.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,306.00
|
| Rate for Payer: Galaxy Health WC |
$2,775.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,938.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,926.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.75
|
| Rate for Payer: Networks By Design Commercial |
$2,122.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,775.25
|
|
|
HC BILIARY CATH RMVL W FLUORO
|
Facility
|
OP
|
$3,265.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
909047537
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$583.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$653.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,469.25
|
| Rate for Payer: Cash Price |
$1,469.25
|
| Rate for Payer: Cash Price |
$1,469.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.00
|
| Rate for Payer: Cigna of CA HMO |
$2,089.60
|
| Rate for Payer: Cigna of CA PPO |
$2,416.10
|
| 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 |
$2,285.50
|
| 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 |
$2,775.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,938.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$583.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$644.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,448.75
|
| Rate for Payer: Networks By Design Commercial |
$2,122.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,775.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,399.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,632.50
|
| 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 BILIARY CATH RMVL W FLUORO
|
Facility
|
IP
|
$3,265.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
909047537
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$653.00 |
| Max. Negotiated Rate |
$2,938.50 |
| Rate for Payer: Adventist Health Commercial |
$653.00
|
| Rate for Payer: Cash Price |
$1,469.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,285.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,306.00
|
| Rate for Payer: Galaxy Health WC |
$2,775.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,938.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,926.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.00
|
| Rate for Payer: Multiplan Commercial |
$2,448.75
|
| Rate for Payer: Networks By Design Commercial |
$2,122.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,775.25
|
|
|
HC BILIARY CATH RMVL W FLUORO
|
Facility
|
OP
|
$3,265.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
909047537
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$583.37 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$653.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,166.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,898.06
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,469.25
|
| Rate for Payer: Cash Price |
$1,469.25
|
| Rate for Payer: Cash Price |
$1,469.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.00
|
| Rate for Payer: Cigna of CA HMO |
$2,089.60
|
| Rate for Payer: Cigna of CA PPO |
$2,416.10
|
| 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 |
$2,285.50
|
| 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 |
$2,775.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,938.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,913.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$583.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$644.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,633.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,563.15
|
| Rate for Payer: Multiplan Commercial |
$2,448.75
|
| Rate for Payer: Multiplan WC |
$1,898.06
|
| Rate for Payer: Networks By Design Commercial |
$2,122.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,166.53
|
| Rate for Payer: Preferred Health Network WC |
$1,936.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,775.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,236.52
|
| Rate for Payer: Prime Health Services WC |
$1,878.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,283.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,632.50
|
| 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 BILIARY COPE LOOP CATH
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Blue Shield of California Commercial |
$335.24
|
| Rate for Payer: Blue Shield of California EPN |
$210.67
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| Rate for Payer: Cigna of CA HMO |
$292.60
|
| Rate for Payer: Cigna of CA PPO |
$292.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$292.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$265.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$246.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: Networks By Design Commercial |
$209.00
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.88
|
| Rate for Payer: United Healthcare All Other HMO |
$152.70
|
| Rate for Payer: United Healthcare HMO Rider |
$149.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.90
|
|
|
HC BILIARY COPE LOOP CATH
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$83.60 |
| Max. Negotiated Rate |
$376.20 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$229.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$313.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$190.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$229.23
|
| Rate for Payer: Blue Shield of California Commercial |
$335.24
|
| Rate for Payer: Blue Shield of California EPN |
$210.67
|
| Rate for Payer: Cash Price |
$188.10
|
| Rate for Payer: Central Health Plan Commercial |
$334.40
|
| Rate for Payer: Cigna of CA HMO |
$292.60
|
| Rate for Payer: Cigna of CA PPO |
$292.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$355.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$355.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$355.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$292.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$167.20
|
| Rate for Payer: Galaxy Health WC |
$355.30
|
| Rate for Payer: Global Benefits Group Commercial |
$250.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$376.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$265.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$151.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$246.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$292.60
|
| Rate for Payer: Multiplan Commercial |
$313.50
|
| Rate for Payer: Networks By Design Commercial |
$209.00
|
| Rate for Payer: Prime Health Services Commercial |
$355.30
|
| Rate for Payer: Riverside University Health System MISP |
$167.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$250.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$250.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.88
|
| Rate for Payer: United Healthcare All Other HMO |
$152.70
|
| Rate for Payer: United Healthcare HMO Rider |
$149.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$355.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$355.30
|
| Rate for Payer: Vantage Medical Group Senior |
$355.30
|
|
