|
HC C GLABRATA AND C KRUSEI NAT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$343.45 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$343.45
|
| Rate for Payer: Blue Shield of California Commercial |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$47.88
|
| Rate for Payer: Blue Shield of California EPN |
$42.08
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Riverside University Health System MISP |
$30.40
|
| Rate for Payer: Riverside University Health System MISP |
$42.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC C GLABRATA AND C KRUSEI NAT
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
OP
|
$8,589.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$776.75 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,717.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,688.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,865.05
|
| Rate for Payer: Cash Price |
$3,865.05
|
| Rate for Payer: Cash Price |
$3,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,871.20
|
| Rate for Payer: Cigna of CA HMO |
$5,496.96
|
| Rate for Payer: Cigna of CA PPO |
$6,355.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,012.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$7,300.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,153.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,730.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$776.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,454.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$858.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$6,441.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$5,582.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$7,300.65
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,153.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,294.50
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CHANGE EXT/INT URETER STENT
|
Facility
|
IP
|
$8,589.00
|
|
|
Service Code
|
CPT 50387
|
| Hospital Charge Code |
909081852
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,717.80 |
| Max. Negotiated Rate |
$7,730.10 |
| Rate for Payer: Adventist Health Commercial |
$1,717.80
|
| Rate for Payer: Cash Price |
$3,865.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,871.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,012.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,435.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,435.60
|
| Rate for Payer: Galaxy Health WC |
$7,300.65
|
| Rate for Payer: Global Benefits Group Commercial |
$5,153.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,730.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,454.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,067.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.80
|
| Rate for Payer: Multiplan Commercial |
$6,441.75
|
| Rate for Payer: Networks By Design Commercial |
$5,582.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,300.65
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
IP
|
$6,070.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,214.00 |
| Max. Negotiated Rate |
$5,463.00 |
| Rate for Payer: Adventist Health Commercial |
$1,214.00
|
| Rate for Payer: Cash Price |
$2,731.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,856.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,249.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,428.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,428.00
|
| Rate for Payer: Galaxy Health WC |
$5,159.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,642.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,463.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,854.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,581.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,214.00
|
| Rate for Payer: Multiplan Commercial |
$4,552.50
|
| Rate for Payer: Networks By Design Commercial |
$3,945.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,159.50
|
|
|
HC CHANGE G-TUBE TO G-J TUBE
|
Facility
|
OP
|
$6,070.00
|
|
|
Service Code
|
CPT 49446
|
| Hospital Charge Code |
909020004
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,214.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,214.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$2,731.50
|
| Rate for Payer: Cash Price |
$2,731.50
|
| Rate for Payer: Cash Price |
$2,731.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,856.00
|
| Rate for Payer: Cigna of CA HMO |
$3,884.80
|
| Rate for Payer: Cigna of CA PPO |
$4,491.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,249.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$5,159.50
|
| Rate for Payer: Global Benefits Group Commercial |
$3,642.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,463.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,569.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,854.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,733.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,214.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$4,552.50
|
| Rate for Payer: Multiplan WC |
$3,840.40
|
| Rate for Payer: Networks By Design Commercial |
$3,945.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Preferred Health Network WC |
$3,918.78
|
| Rate for Payer: Prime Health Services Commercial |
$5,159.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,642.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC CHANGE OF CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
OP
|
$2,454.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
909000710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$180.58 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$490.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$896.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA 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 |
$1,351.26
|
| 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 |
$1,104.30
|
| Rate for Payer: Cash Price |
$1,104.30
|
| Rate for Payer: Cash Price |
$1,104.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,963.20
|
| Rate for Payer: Cigna of CA HMO |
$1,570.56
|
| Rate for Payer: Cigna of CA PPO |
$1,815.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,717.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.79
|
| Rate for Payer: EPIC Health Plan Senior |
$986.52
|
| Rate for Payer: Galaxy Health WC |
$2,085.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,472.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,208.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$180.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,558.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.77
|
| Rate for Payer: Multiplan Commercial |
$1,840.50
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,595.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$896.84
|
| Rate for Payer: Preferred Health Network WC |
$1,378.84
|
| Rate for Payer: Prime Health Services Commercial |
$2,085.90
|
| Rate for Payer: Prime Health Services Medicare |
$950.65
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$986.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,472.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,227.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$896.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
HC CHANGE OF CYSTOSTOMY TUBE COMPLICATED
|
Facility
|
IP
|
$2,454.00
|
|
|
Service Code
|
CPT 51710
|
| Hospital Charge Code |
909000710
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$490.80 |
| Max. Negotiated Rate |
$2,208.60 |
| Rate for Payer: Adventist Health Commercial |
$490.80
|
| Rate for Payer: Cash Price |
$1,104.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,963.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,717.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$981.60
|
| Rate for Payer: EPIC Health Plan Senior |
$981.60
|
| Rate for Payer: Galaxy Health WC |
$2,085.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,472.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,208.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,558.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,447.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.80
|
| Rate for Payer: Multiplan Commercial |
$1,840.50
|
| Rate for Payer: Networks By Design Commercial |
$1,595.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,085.90
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
OP
|
$5,413.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$85.59 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,082.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$2,435.85
|
| Rate for Payer: Cash Price |
$2,435.85
|
| Rate for Payer: Cash Price |
$2,435.85
|
| Rate for Payer: Cash Price |
$2,435.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,330.40
|
| Rate for Payer: Cigna of CA HMO |
$3,464.32
|
| Rate for Payer: Cigna of CA PPO |
$4,005.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,789.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$4,601.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,871.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,437.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$4,059.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$3,518.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$4,601.05
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,706.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,706.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,706.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,706.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CHANGE URETEROSTOMY TUBE
|
Facility
|
IP
|
$5,413.00
|
|
|
Service Code
|
CPT 50688
|
| Hospital Charge Code |
900501678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,082.60 |
| Max. Negotiated Rate |
$4,871.70 |
| Rate for Payer: Adventist Health Commercial |
$1,082.60
|
| Rate for Payer: Cash Price |
$2,435.85
|
| Rate for Payer: Central Health Plan Commercial |
$4,330.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,789.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,165.20
|
| Rate for Payer: Galaxy Health WC |
$4,601.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,247.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,871.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,437.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,193.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.60
|
| Rate for Payer: Multiplan Commercial |
$4,059.75
|
| Rate for Payer: Networks By Design Commercial |
$3,518.45
|
| Rate for Payer: Prime Health Services Commercial |
$4,601.05
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
|
OP
|
$12,924.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,344.34 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,584.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,688.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,407.11
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$5,815.80
|
| Rate for Payer: Cash Price |
$5,815.80
|
| Rate for Payer: Cash Price |
$5,815.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,339.20
|
| Rate for Payer: Cigna of CA HMO |
$8,271.36
|
| Rate for Payer: Cigna of CA PPO |
$9,563.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,046.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$10,985.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,754.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,631.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,344.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,206.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,589.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,584.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$9,693.00
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$8,400.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$10,985.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,754.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,462.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CHANGE URETER STENT, PERCUT
|
Facility
|
IP
|
$12,924.00
|
|
|
Service Code
|
CPT 50382
|
| Hospital Charge Code |
909081850
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,584.80 |
| Max. Negotiated Rate |
$11,631.60 |
| Rate for Payer: Adventist Health Commercial |
$2,584.80
|
| Rate for Payer: Cash Price |
$5,815.80
|
| Rate for Payer: Central Health Plan Commercial |
$10,339.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,046.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,169.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,169.60
|
| Rate for Payer: Galaxy Health WC |
$10,985.40
|
| Rate for Payer: Global Benefits Group Commercial |
$7,754.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,631.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,206.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,625.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,584.80
|
| Rate for Payer: Multiplan Commercial |
$9,693.00
|
| Rate for Payer: Networks By Design Commercial |
$8,400.60
|
| Rate for Payer: Prime Health Services Commercial |
$10,985.40
|
|
|
HC CHARTIS CATHETER
|
Facility
|
OP
|
$3,783.00
|
|
| Hospital Charge Code |
900800954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.60 |
| Max. Negotiated Rate |
$3,404.70 |
| Rate for Payer: Adventist Health Commercial |
$756.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,297.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,080.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,837.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,831.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,200.57
|
| Rate for Payer: Blue Shield of California Commercial |
$2,398.42
|
| Rate for Payer: Blue Shield of California EPN |
$1,509.42
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| Rate for Payer: Cigna of CA HMO |
$2,421.12
|
| Rate for Payer: Cigna of CA PPO |
$2,799.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,215.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,215.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,648.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,513.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,513.20
|
| Rate for Payer: Galaxy Health WC |
$3,215.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,269.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,404.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,402.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,373.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,231.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,648.10
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
| Rate for Payer: Networks By Design Commercial |
$2,458.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,215.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,513.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,269.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,269.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,891.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,891.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,891.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,891.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,215.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,215.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3,215.55
|
|
|
HC CHARTIS CATHETER
|
Facility
|
IP
|
$3,783.00
|
|
| Hospital Charge Code |
900800954
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.60 |
| Max. Negotiated Rate |
$3,404.70 |
| Rate for Payer: Adventist Health Commercial |
$756.60
|
| Rate for Payer: Cash Price |
$1,702.35
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,648.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,513.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,513.20
|
| Rate for Payer: Galaxy Health WC |
$3,215.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,269.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,404.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,402.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,231.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.60
|
| Rate for Payer: Multiplan Commercial |
$2,837.25
|
| Rate for Payer: Networks By Design Commercial |
$2,458.95
|
| Rate for Payer: Prime Health Services Commercial |
$3,215.55
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
|
|
HC CHECKOUT ORTHO PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900400050
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Cigna of CA HMO |
$138.24
|
| Rate for Payer: Cigna of CA PPO |
$159.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Riverside University Health System MISP |
$86.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.60
|
| Rate for Payer: Vantage Medical Group Senior |
$183.60
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN MCAL
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
901300080
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Cigna of CA HMO |
$138.24
|
| Rate for Payer: Cigna of CA PPO |
$159.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Riverside University Health System MISP |
$86.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.60
|
| Rate for Payer: Vantage Medical Group Senior |
$183.60
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN OT
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905104155
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Cigna of CA HMO |
$138.24
|
| Rate for Payer: Cigna of CA PPO |
$159.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Riverside University Health System MISP |
$86.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.60
|
| Rate for Payer: Vantage Medical Group Senior |
$183.60
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN OT
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905104155
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905103155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900417703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.20 |
| Max. Negotiated Rate |
$194.40 |
| Rate for Payer: Adventist Health Commercial |
$43.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
900417703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Cigna of CA HMO |
$138.24
|
| Rate for Payer: Cigna of CA PPO |
$159.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Riverside University Health System MISP |
$86.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.60
|
| Rate for Payer: Vantage Medical Group Senior |
$183.60
|
|
|
HC CHECKOUT ORTHO/PROSTH USE 15MIN PT
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905103155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$78.41 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$295.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$118.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$162.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| Rate for Payer: Cigna of CA HMO |
$138.24
|
| Rate for Payer: Cigna of CA PPO |
$159.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$183.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$183.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$183.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$151.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.40
|
| Rate for Payer: EPIC Health Plan Senior |
$86.40
|
| Rate for Payer: Galaxy Health WC |
$183.60
|
| Rate for Payer: Global Benefits Group Commercial |
$129.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$194.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$137.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$127.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$151.20
|
| Rate for Payer: Multiplan Commercial |
$162.00
|
| Rate for Payer: Networks By Design Commercial |
$140.40
|
| Rate for Payer: Prime Health Services Commercial |
$183.60
|
| Rate for Payer: Riverside University Health System MISP |
$86.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$129.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$129.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$183.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$183.60
|
| Rate for Payer: Vantage Medical Group Senior |
$183.60
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$280.20 |
| Max. Negotiated Rate |
$1,260.90 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Cash Price |
$630.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$980.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.40
|
| Rate for Payer: EPIC Health Plan Senior |
$560.40
|
| Rate for Payer: Galaxy Health WC |
$1,190.85
|
| Rate for Payer: Global Benefits Group Commercial |
$840.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,260.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$889.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$826.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
|
