|
HC CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$295.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$358.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: Cigna of CA HMO |
$390.40
|
| Rate for Payer: Cigna of CA PPO |
$451.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.00
|
| Rate for Payer: InnovAge PACE Commercial |
$305.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$427.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$427.00
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Riverside University Health System MISP |
$244.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC CERVICAL DISCOGRAPHY, 1 LEV
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 62291
|
| Hospital Charge Code |
909000184
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Adventist Health Commercial |
$122.00
|
| Rate for Payer: Cash Price |
$335.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Senior |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$377.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.00
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Networks By Design Commercial |
$396.50
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
|
IP
|
$9,099.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,819.80 |
| Max. Negotiated Rate |
$8,189.10 |
| Rate for Payer: Adventist Health Commercial |
$1,819.80
|
| Rate for Payer: Cash Price |
$5,004.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,279.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,639.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,639.60
|
| Rate for Payer: Galaxy Health WC |
$7,734.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,459.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,189.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,069.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,466.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,632.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,819.80
|
| Rate for Payer: Multiplan Commercial |
$6,824.25
|
| Rate for Payer: Networks By Design Commercial |
$5,914.35
|
| Rate for Payer: Prime Health Services Commercial |
$7,734.15
|
|
|
HC CERVICAL PUNCTURE (FLUORO)
|
Facility
|
OP
|
$9,099.00
|
|
|
Service Code
|
CPT 61050
|
| Hospital Charge Code |
909000197
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$130.63 |
| Max. Negotiated Rate |
$8,189.10 |
| Rate for Payer: Adventist Health Commercial |
$1,819.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$375.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,004.45
|
| Rate for Payer: Cash Price |
$5,004.45
|
| Rate for Payer: Cash Price |
$5,004.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,279.20
|
| Rate for Payer: Cigna of CA HMO |
$5,823.36
|
| Rate for Payer: Cigna of CA PPO |
$6,733.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$7,734.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5,459.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,189.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$130.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,069.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,819.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$6,824.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$5,914.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$7,734.15
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,459.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
IP
|
$2,064.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$412.80 |
| Max. Negotiated Rate |
$1,857.60 |
| Rate for Payer: Adventist Health Commercial |
$412.80
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,651.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$825.60
|
| Rate for Payer: EPIC Health Plan Senior |
$825.60
|
| Rate for Payer: Galaxy Health WC |
$1,754.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,238.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,857.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$786.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,277.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Multiplan Commercial |
$1,548.00
|
| Rate for Payer: Networks By Design Commercial |
$1,341.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,754.40
|
|
|
HC CERVICAL PUNCTURE FOR MYELO
|
Facility
|
OP
|
$2,064.00
|
|
|
Service Code
|
CPT 61055
|
| Hospital Charge Code |
909000179
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.33 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$412.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$375.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,651.20
|
| Rate for Payer: Cigna of CA HMO |
$1,320.96
|
| Rate for Payer: Cigna of CA PPO |
$1,527.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,754.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,238.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,857.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$243.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: InnovAge PACE Commercial |
$562.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,376.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$268.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$502.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,548.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,341.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$375.07
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$1,754.40
|
| Rate for Payer: Prime Health Services Medicare |
$397.57
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$412.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,238.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.62
|
| Rate for Payer: Blue Shield of California Commercial |
$172.30
|
| Rate for Payer: Blue Shield of California EPN |
$112.52
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.00
|
| Rate for Payer: United Healthcare All Other HMO |
$141.00
|
| Rate for Payer: United Healthcare HMO Rider |
$141.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
770
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$136.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.62
|
| Rate for Payer: Blue Shield of California Commercial |
$172.30
|
| Rate for Payer: Blue Shield of California EPN |
$112.52
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: Cigna of CA HMO |
$180.48
|
| Rate for Payer: Cigna of CA PPO |
$208.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$169.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$169.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$141.00
|
| Rate for Payer: United Healthcare All Other HMO |
$141.00
|
| Rate for Payer: United Healthcare HMO Rider |
$141.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$141.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC CERVICAL/VAGINAL CANCER SCREEN
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT G0101
|
| Hospital Charge Code |
902890216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.40 |
| Max. Negotiated Rate |
$253.80 |
| Rate for Payer: Adventist Health Commercial |
$56.40
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Central Health Plan Commercial |
$225.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$112.80
|
| Rate for Payer: EPIC Health Plan Senior |
$112.80
|
| Rate for Payer: Galaxy Health WC |
$239.70
|
| Rate for Payer: Global Benefits Group Commercial |
$169.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$253.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$188.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$174.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.40
|
| Rate for Payer: Multiplan Commercial |
$211.50
|
| Rate for Payer: Networks By Design Commercial |
$183.30
|
| Rate for Payer: Prime Health Services Commercial |
$239.70
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
OP
|
$1,944.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$138.96 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$388.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,652.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,069.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,458.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,555.20
|
| Rate for Payer: Cigna of CA HMO |
$1,244.16
|
| Rate for Payer: Cigna of CA PPO |
$1,438.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,652.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,652.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,652.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.60
|
| Rate for Payer: EPIC Health Plan Senior |
$777.60
|
| Rate for Payer: Galaxy Health WC |
$1,652.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,166.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,749.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$138.96
|
| Rate for Payer: InnovAge PACE Commercial |
$972.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,296.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,203.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,360.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,360.80
|
| Rate for Payer: Multiplan Commercial |
$1,458.00
|
| Rate for Payer: Networks By Design Commercial |
$1,263.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,652.40
|
| Rate for Payer: Riverside University Health System MISP |
$777.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,166.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,652.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,652.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,652.40
|
|
|
HC CERV/THOR FACET INJ 3RD EA ADD
|
Facility
|
IP
|
$1,944.00
|
|
|
Service Code
|
CPT 64492
|
| Hospital Charge Code |
909020049
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$388.80 |
| Max. Negotiated Rate |
$1,749.60 |
| Rate for Payer: Adventist Health Commercial |
$388.80
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,555.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$777.60
|
| Rate for Payer: EPIC Health Plan Senior |
$777.60
|
| Rate for Payer: Galaxy Health WC |
$1,652.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,166.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,749.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,296.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$740.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,203.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$388.80
|
| Rate for Payer: Multiplan Commercial |
$1,458.00
|
| Rate for Payer: Networks By Design Commercial |
$1,263.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,652.40
|
|
|
HC CESAREAN DELIVERY ONLY
|
Facility
|
IP
|
$7,016.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
900501514
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$1,403.20 |
| Max. Negotiated Rate |
$6,314.40 |
| Rate for Payer: Adventist Health Commercial |
$1,403.20
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,612.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,806.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,806.40
|
| Rate for Payer: Galaxy Health WC |
$5,963.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,209.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,314.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,673.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,342.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.20
|
| Rate for Payer: Multiplan Commercial |
$5,262.00
|
| Rate for Payer: Networks By Design Commercial |
$4,560.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,963.60
|
|
|
HC CESAREAN DELIVERY ONLY
|
Facility
|
OP
|
$7,016.00
|
|
|
Service Code
|
CPT 59514
|
| Hospital Charge Code |
900501514
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$581.00 |
| Max. Negotiated Rate |
$11,240.00 |
| Rate for Payer: Adventist Health Commercial |
$1,403.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,260.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,963.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,858.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,262.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,407.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,240.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,286.78
|
| Rate for Payer: Blue Shield of California EPN |
$2,799.38
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Cash Price |
$3,858.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,612.80
|
| Rate for Payer: Cigna of CA HMO |
$4,490.24
|
| Rate for Payer: Cigna of CA PPO |
$5,191.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,963.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,963.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,963.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,806.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,806.40
|
| Rate for Payer: Galaxy Health WC |
$5,963.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,209.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,314.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.92
|
| Rate for Payer: InnovAge PACE Commercial |
$3,508.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,679.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,034.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,342.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,403.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,911.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,911.20
|
| Rate for Payer: Multiplan Commercial |
$5,262.00
|
| Rate for Payer: Networks By Design Commercial |
$4,560.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,963.60
|
| Rate for Payer: Riverside University Health System MISP |
$2,806.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,209.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,209.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,963.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,963.60
|
| Rate for Payer: Vantage Medical Group Senior |
$5,963.60
|
|
|
HC C GLABRATA AND C KRUSEI NAT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 87481 59
|
| Hospital Charge Code |
900912494
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
|
|
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 |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| 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 HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$46.13
|
| Rate for Payer: Blue Shield of California EPN |
$30.17
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Cash Price |
$41.80
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$48.64
|
| Rate for Payer: Cigna of CA PPO |
$56.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| 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: InnovAge PACE Commercial |
$38.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Riverside University Health System MISP |
$30.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| 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 HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| 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 Senior |
$64.60
|
|
|
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 |
$7,730.10 |
| Rate for Payer: Adventist Health Commercial |
$1,717.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,602.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$4,723.95
|
| Rate for Payer: Cash Price |
$4,723.95
|
| Rate for Payer: Cash Price |
$4,723.95
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| 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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$776.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,728.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$858.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,717.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| 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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,153.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| 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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
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 |
$4,723.95
|
| Rate for Payer: Central Health Plan Commercial |
$6,871.20
|
| 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 Permanente of CA Commercial/Self Funded |
$5,728.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,272.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,316.59
|
| 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
|
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 |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$1,214.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,840.40
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$3,338.50
|
| Rate for Payer: Cash Price |
$3,338.50
|
| Rate for Payer: Cash Price |
$3,338.50
|
| 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 |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| 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 |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,569.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,048.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,733.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,214.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| 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 |
$2,410.32
|
| 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 |
$2,554.94
|
| Rate for Payer: Prime Health Services WC |
$3,801.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,642.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| 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 |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
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 |
$3,338.50
|
| Rate for Payer: Central Health Plan Commercial |
$4,856.00
|
| 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 Permanente of CA Commercial/Self Funded |
$4,048.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,312.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,757.33
|
| 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 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 |
$1,349.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,963.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,636.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$934.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,519.03
|
| 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 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 |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$490.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$848.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,351.26
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,349.70
|
| Rate for Payer: Cash Price |
$1,349.70
|
| Rate for Payer: Cash Price |
$1,349.70
|
| 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 |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| 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 |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$180.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: InnovAge PACE Commercial |
$1,272.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,636.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$199.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,136.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| 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 |
$848.09
|
| 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 |
$898.98
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$932.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,472.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
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 |
$2,977.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,330.40
|
| 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 Permanente of CA Commercial/Self Funded |
$3,610.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,062.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,350.65
|
| 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 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 |
$4,871.70 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$2,977.15
|
| Rate for Payer: Cash Price |
$2,977.15
|
| Rate for Payer: Cash Price |
$2,977.15
|
| Rate for Payer: Cash Price |
$2,977.15
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| 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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,610.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,082.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| 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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| 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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
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 |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$2,584.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,602.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Blue Shield of California Commercial |
$4,245.30
|
| Rate for Payer: Blue Shield of California EPN |
$3,165.61
|
| Rate for Payer: Cash Price |
$7,108.20
|
| Rate for Payer: Cash Price |
$7,108.20
|
| Rate for Payer: Cash Price |
$7,108.20
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| 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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,344.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,589.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,584.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| 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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,754.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
