|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
906820180
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC ABD/PEL/LE ART, 2ND ORDR CA
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
909081324
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$442.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$483.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Media |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$603.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$281.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Riverside University Health System MISP |
$322.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
IP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$724.50 |
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$306.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
909081325
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$442.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$483.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Media |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$603.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$281.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Riverside University Health System MISP |
$322.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC ABD/PEL/LE ART, 3RD ORDR CA
|
Facility
|
OP
|
$805.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
906820181
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$684.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$442.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$442.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$483.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Cash Price |
$362.25
|
| Rate for Payer: Central Health Plan Commercial |
$644.00
|
| Rate for Payer: Cigna of CA PPO |
$595.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$684.25
|
| Rate for Payer: Dignity Health Media |
$684.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$684.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$322.00
|
| Rate for Payer: Galaxy Health WC |
$684.25
|
| Rate for Payer: Global Benefits Group Commercial |
$483.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$724.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$603.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$281.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$536.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$603.75
|
| Rate for Payer: Networks By Design Commercial |
$523.25
|
| Rate for Payer: Prime Health Services Commercial |
$684.25
|
| Rate for Payer: Riverside University Health System MISP |
$322.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$483.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$684.25
|
| Rate for Payer: Vantage Medical Group Senior |
$684.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$399.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Central Health Plan Commercial |
$532.00
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$565.25
|
| Rate for Payer: Dignity Health Media |
$565.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$598.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$498.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$498.75
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
| Rate for Payer: Riverside University Health System MISP |
$266.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.25
|
| Rate for Payer: Vantage Medical Group Senior |
$565.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$87.72 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$565.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$365.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$365.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$399.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Central Health Plan Commercial |
$532.00
|
| Rate for Payer: Cigna of CA PPO |
$492.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$565.25
|
| Rate for Payer: Dignity Health Media |
$565.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$598.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$498.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$232.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$498.75
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
| Rate for Payer: Riverside University Health System MISP |
$266.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$399.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.25
|
| Rate for Payer: Vantage Medical Group Senior |
$565.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
909081326
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Central Health Plan Commercial |
$532.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$598.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$498.75
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
|
|
HC ABD/PEL/LE ART, ADDL 2ND/3R
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
906820182
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$133.00 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Cash Price |
$299.25
|
| Rate for Payer: Central Health Plan Commercial |
$532.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$266.00
|
| Rate for Payer: Galaxy Health WC |
$565.25
|
| Rate for Payer: Global Benefits Group Commercial |
$399.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$598.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$443.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$498.75
|
| Rate for Payer: Networks By Design Commercial |
$432.25
|
| Rate for Payer: Prime Health Services Commercial |
$565.25
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
905352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.40 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Blue Shield of California EPN |
$417.59
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$297.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$391.00
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$295.28
|
| Rate for Payer: United Healthcare All Other HMO |
$288.40
|
| Rate for Payer: United Healthcare HMO Rider |
$282.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.06
|
|
|
HC ABDUCTION BAR ADDITION LE
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT L2300
|
| Hospital Charge Code |
905352300
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$273.70 |
| Max. Negotiated Rate |
$703.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$664.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$430.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$430.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$378.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.01
|
| Rate for Payer: Blue Distinction Transplant |
$469.20
|
| Rate for Payer: Blue Shield of California Commercial |
$586.50
|
| Rate for Payer: Blue Shield of California EPN |
$425.41
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Cash Price |
$351.90
|
| Rate for Payer: Central Health Plan Commercial |
$625.60
|
| Rate for Payer: Cigna of CA HMO |
$547.40
|
| Rate for Payer: Cigna of CA PPO |
$547.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$664.70
|
| Rate for Payer: Dignity Health Media |
$664.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$664.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$312.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$312.80
|
| Rate for Payer: Galaxy Health WC |
$664.70
|
| Rate for Payer: Global Benefits Group Commercial |
$469.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$703.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$586.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$273.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$521.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$410.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.62
|
| Rate for Payer: Multiplan Commercial |
$586.50
|
| Rate for Payer: Networks By Design Commercial |
$391.00
|
| Rate for Payer: Prime Health Services Commercial |
$664.70
|
| Rate for Payer: Riverside University Health System MISP |
$312.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$469.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$391.00
|
| Rate for Payer: United Healthcare All Other HMO |
$391.00
|
| Rate for Payer: United Healthcare HMO Rider |
$391.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$664.70
|
| Rate for Payer: Vantage Medical Group Senior |
$664.70
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
905352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$150.50 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$365.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$236.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$236.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$208.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.04
|
| Rate for Payer: Blue Distinction Transplant |
$258.00
|
| Rate for Payer: Blue Shield of California Commercial |
$322.50
|
| Rate for Payer: Blue Shield of California EPN |
$233.92
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$365.50
|
| Rate for Payer: Dignity Health Media |
$365.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$365.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$322.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.30
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: Riverside University Health System MISP |
$172.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$258.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$258.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$215.00
|
| Rate for Payer: United Healthcare All Other HMO |
$215.00
|
| Rate for Payer: United Healthcare HMO Rider |
$215.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$365.50
|
| Rate for Payer: Vantage Medical Group Senior |
$365.50
|
|
|
HC ABDUCTION BAR STRAIGHT ADDITION LE
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT L2310
|
| Hospital Charge Code |
905352310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$86.00 |
| Max. Negotiated Rate |
$387.00 |
| Rate for Payer: Blue Shield of California EPN |
$229.62
|
| Rate for Payer: Cash Price |
$193.50
|
| Rate for Payer: Central Health Plan Commercial |
$344.00
|
| Rate for Payer: Cigna of CA HMO |
$301.00
|
| Rate for Payer: Cigna of CA PPO |
$301.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$172.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$172.00
|
| Rate for Payer: Galaxy Health WC |
$365.50
|
| Rate for Payer: Global Benefits Group Commercial |
$258.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$387.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$286.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$163.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.00
|
| Rate for Payer: Multiplan Commercial |
$322.50
|
| Rate for Payer: Networks By Design Commercial |
$215.00
|
| Rate for Payer: Prime Health Services Commercial |
$365.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$162.37
|
| Rate for Payer: United Healthcare All Other HMO |
$158.58
|
| Rate for Payer: United Healthcare HMO Rider |
$155.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.90
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
|
|
HC ABLAT CERV/THORAC EA ADD LEVEL
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
CPT 64634
|
| Hospital Charge Code |
909000265
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,817.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,817.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,982.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Cigna of CA PPO |
$2,444.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,808.40
|
| Rate for Payer: Dignity Health Media |
$2,808.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,808.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,478.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,156.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,321.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,982.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,808.40
|
| Rate for Payer: Vantage Medical Group Senior |
$2,808.40
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
IP
|
$5,438.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,087.60 |
| Max. Negotiated Rate |
$4,894.20 |
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,175.20
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,071.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
|
|
HC ABLAT CERV/THORAC NERVE SNGL L
|
Facility
|
OP
|
$5,438.00
|
|
|
Service Code
|
CPT 64633
|
| Hospital Charge Code |
909000264
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$378.82 |
| Max. Negotiated Rate |
$15,354.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,412.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,412.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,262.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$2,412.38
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Cash Price |
$2,447.10
|
| Rate for Payer: Central Health Plan Commercial |
$4,350.40
|
| Rate for Payer: Cigna of CA PPO |
$4,024.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Dignity Health Media |
$2,412.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,653.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,256.71
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,412.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,412.38
|
| Rate for Payer: Galaxy Health WC |
$4,622.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,262.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,894.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,078.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,956.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,980.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,412.38
|
| Rate for Payer: InnovAge PACE Commercial |
$3,618.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,627.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$378.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,412.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,087.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,232.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,232.59
|
| Rate for Payer: Multiplan Commercial |
$4,078.50
|
| Rate for Payer: Networks By Design Commercial |
$3,534.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,622.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,557.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,653.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,262.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,375.00
|
| Rate for Payer: United Healthcare All Other HMO |
$15,354.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,681.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,618.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,653.62
|
| Rate for Payer: Vantage Medical Group Senior |
$2,412.38
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
IP
|
$22,319.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,463.80 |
| Max. Negotiated Rate |
$20,087.10 |
| Rate for Payer: Cash Price |
$10,043.55
|
| Rate for Payer: Central Health Plan Commercial |
$17,855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,927.60
|
| Rate for Payer: Galaxy Health WC |
$18,971.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,087.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,886.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,503.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.80
|
| Rate for Payer: Multiplan Commercial |
$16,739.25
|
| Rate for Payer: Networks By Design Commercial |
$14,507.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,971.15
|
|
|
HC ABLATION,1 OR MORE LIVER TUM
|
Facility
|
OP
|
$22,319.00
|
|
|
Service Code
|
CPT 47382
|
| Hospital Charge Code |
909000246
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,052.56 |
| Max. Negotiated Rate |
$27,445.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,209.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,209.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,877.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,389.00
|
| Rate for Payer: Blue Distinction Transplant |
$13,391.40
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$7,209.21
|
| Rate for Payer: Cash Price |
$10,043.55
|
| Rate for Payer: Cash Price |
$10,043.55
|
| Rate for Payer: Central Health Plan Commercial |
$17,855.20
|
| Rate for Payer: Cigna of CA PPO |
$16,516.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Dignity Health Media |
$7,209.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,930.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,732.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,209.21
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,209.21
|
| Rate for Payer: Galaxy Health WC |
$18,971.15
|
| Rate for Payer: Global Benefits Group Commercial |
$13,391.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,087.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16,739.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,823.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,895.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,209.21
|
| Rate for Payer: InnovAge PACE Commercial |
$10,813.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,886.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,052.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,209.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,463.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,660.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,660.34
|
| Rate for Payer: Multiplan Commercial |
$16,739.25
|
| Rate for Payer: Networks By Design Commercial |
$14,507.35
|
| Rate for Payer: Prime Health Services Commercial |
$18,971.15
|
| Rate for Payer: Prime Health Services Medicare |
$7,641.76
|
| Rate for Payer: Riverside University Health System MISP |
$7,930.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,391.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,813.00
|
| Rate for Payer: United Healthcare All Other HMO |
$27,445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$17,214.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,742.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,813.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,930.13
|
| Rate for Payer: Vantage Medical Group Senior |
$7,209.21
|
|
|
HC ABLATION CRYO SPRAY
|
Facility
|
IP
|
$4,875.00
|
|
| Hospital Charge Code |
900800272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$3,168.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
|
|
HC ABLATION CRYO SPRAY
|
Facility
|
OP
|
$4,875.00
|
|
| Hospital Charge Code |
900800272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$975.00 |
| Max. Negotiated Rate |
$4,387.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,960.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,681.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,681.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,360.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,880.15
|
| Rate for Payer: Blue Distinction Transplant |
$2,925.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,066.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,383.88
|
| Rate for Payer: Cash Price |
$2,193.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,900.00
|
| Rate for Payer: Cigna of CA HMO |
$3,120.00
|
| Rate for Payer: Cigna of CA PPO |
$3,607.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,143.75
|
| Rate for Payer: Dignity Health Media |
$4,143.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,143.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,950.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,950.00
|
| Rate for Payer: Galaxy Health WC |
$4,143.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,925.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,387.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,656.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,706.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,251.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,857.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$3,656.25
|
| Rate for Payer: Networks By Design Commercial |
$3,168.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,143.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,950.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,925.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,925.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,437.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,437.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,437.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,437.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,143.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,143.75
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906820252
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$13,979.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$979.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$633.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$691.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Central Health Plan Commercial |
$921.60
|
| Rate for Payer: Cigna of CA PPO |
$852.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$979.20
|
| Rate for Payer: Dignity Health Media |
$979.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$979.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$460.80
|
| Rate for Payer: Galaxy Health WC |
$979.20
|
| Rate for Payer: Global Benefits Group Commercial |
$691.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,036.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$864.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$403.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.40
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$748.80
|
| Rate for Payer: Prime Health Services Commercial |
$979.20
|
| Rate for Payer: Riverside University Health System MISP |
$460.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$691.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$691.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$979.20
|
| Rate for Payer: Vantage Medical Group Senior |
$979.20
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$13,979.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$979.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$633.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$633.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$691.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Central Health Plan Commercial |
$921.60
|
| Rate for Payer: Cigna of CA PPO |
$852.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$979.20
|
| Rate for Payer: Dignity Health Media |
$979.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$979.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$460.80
|
| Rate for Payer: Galaxy Health WC |
$979.20
|
| Rate for Payer: Global Benefits Group Commercial |
$691.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,036.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$864.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$403.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.40
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$748.80
|
| Rate for Payer: Prime Health Services Commercial |
$979.20
|
| Rate for Payer: Riverside University Health System MISP |
$460.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$691.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$691.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$979.20
|
| Rate for Payer: Vantage Medical Group Senior |
$979.20
|
|
|
HC ABLATION L/R ATRIUM AFIB
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 93657
|
| Hospital Charge Code |
906811449
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$230.40 |
| Max. Negotiated Rate |
$1,036.80 |
| Rate for Payer: Cash Price |
$518.40
|
| Rate for Payer: Central Health Plan Commercial |
$921.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$460.80
|
| Rate for Payer: Galaxy Health WC |
$979.20
|
| Rate for Payer: Global Benefits Group Commercial |
$691.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,036.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$768.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$438.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$230.40
|
| Rate for Payer: Multiplan Commercial |
$864.00
|
| Rate for Payer: Networks By Design Commercial |
$748.80
|
| Rate for Payer: Prime Health Services Commercial |
$979.20
|
|
