|
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 |
$7,108.20
|
| Rate for Payer: Central Health Plan Commercial |
$10,339.20
|
| 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 Permanente of CA Commercial/Self Funded |
$8,620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,924.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,999.96
|
| 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
|
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 |
$2,080.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,026.40
|
| 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 Permanente of CA Commercial/Self Funded |
$2,523.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,441.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,341.68
|
| 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 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 |
$2,221.76
|
| Rate for Payer: Blue Shield of California Commercial |
$2,311.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,509.42
|
| Rate for Payer: Cash Price |
$2,080.65
|
| 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: 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: InnovAge PACE Commercial |
$1,891.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,523.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,441.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,341.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$756.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,648.10
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| 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 Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| 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 |
$82.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| 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: 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: InnovAge PACE Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| 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 Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| 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 |
$82.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| 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: 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: InnovAge PACE Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| 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 Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| 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 OT
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 97763
|
| Hospital Charge Code |
905104155
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$82.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| 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: 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: InnovAge PACE Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
$82.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| 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: 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: InnovAge PACE Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.20
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| 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 Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| 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 |
$118.80
|
| Rate for Payer: Central Health Plan Commercial |
$172.80
|
| 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 Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| 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 |
$82.30 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$88.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$131.18
|
| 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 |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| 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: 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: InnovAge PACE Commercial |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$144.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$82.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$133.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$151.20
|
| Rate for Payer: Molina Healthcare of CA 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
|
750
|
| Min. Negotiated Rate |
$280.20 |
| Max. Negotiated Rate |
$1,260.90 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| 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 Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$867.22
|
| 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
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$678.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$822.81
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: Cigna of CA HMO |
$896.64
|
| Rate for Payer: Cigna of CA PPO |
$1,036.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.60
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$280.20 |
| Max. Negotiated Rate |
$1,260.90 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| 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 Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$867.22
|
| 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
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$678.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$822.81
|
| Rate for Payer: Blue Shield of California Commercial |
$979.68
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: Cigna of CA HMO |
$896.64
|
| Rate for Payer: Cigna of CA PPO |
$1,036.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.96
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.57 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$678.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$822.81
|
| Rate for Payer: Blue Shield of California Commercial |
$856.01
|
| Rate for Payer: Blue Shield of California EPN |
$559.00
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: Cigna of CA HMO |
$896.64
|
| Rate for Payer: Cigna of CA PPO |
$1,036.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$840.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.50
|
| Rate for Payer: United Healthcare All Other HMO |
$700.50
|
| Rate for Payer: United Healthcare HMO Rider |
$700.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| 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 |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| 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 |
$402.27
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: Cigna of CA HMO |
$896.64
|
| Rate for Payer: Cigna of CA PPO |
$1,036.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$700.50
|
| Rate for Payer: United Healthcare All Other HMO |
$700.50
|
| Rate for Payer: United Healthcare HMO Rider |
$700.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$700.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$280.20 |
| Max. Negotiated Rate |
$1,260.90 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| 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 Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$867.22
|
| 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
|
|
|
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 |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| 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 Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$867.22
|
| 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
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$280.20 |
| Max. Negotiated Rate |
$1,260.90 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| 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 Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$533.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$867.22
|
| 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
|
|
|
HC CHEM CAUT OF GRANULATION TISS
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 17250
|
| Hospital Charge Code |
900501050
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$38.19 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Commercial |
$574.41
|
| 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 |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$822.81
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Cash Price |
$770.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: Cigna of CA HMO |
$896.64
|
| Rate for Payer: Cigna of CA PPO |
$1,036.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| 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: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$934.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$840.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC CHEMO ADM IA GT 8 HRS W/PUMP
|
Facility
|
OP
|
$1,161.00
|
|
|
Service Code
|
CPT 96425
|
| Hospital Charge Code |
911800813
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$227.64 |
| Max. Negotiated Rate |
$1,461.00 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$421.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$705.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$742.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$990.00
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$928.80
|
| Rate for Payer: Cigna of CA HMO |
$743.04
|
| Rate for Payer: Cigna of CA PPO |
$859.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$986.85
|
| Rate for Payer: Global Benefits Group Commercial |
$696.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$227.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$518.38
|
| Rate for Payer: InnovAge PACE Commercial |
$632.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$774.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$290.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$870.75
|
| Rate for Payer: Networks By Design Commercial |
$754.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$421.45
|
| Rate for Payer: Prime Health Services Commercial |
$986.85
|
| Rate for Payer: Prime Health Services Medicare |
$446.74
|
| Rate for Payer: Riverside University Health System MISP |
$463.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$696.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$696.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,352.00
|
| Rate for Payer: United Healthcare HMO Rider |
$887.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$813.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC CHEMO ADM IA GT 8 HRS W/PUMP
|
Facility
|
IP
|
$1,161.00
|
|
|
Service Code
|
CPT 96425
|
| Hospital Charge Code |
911800813
|
|
Hospital Revenue Code
|
335
|
| Min. Negotiated Rate |
$232.20 |
| Max. Negotiated Rate |
$1,044.90 |
| Rate for Payer: Adventist Health Commercial |
$232.20
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$928.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.40
|
| Rate for Payer: EPIC Health Plan Senior |
$464.40
|
| Rate for Payer: Galaxy Health WC |
$986.85
|
| Rate for Payer: Global Benefits Group Commercial |
$696.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,044.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$774.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$442.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$718.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.20
|
| Rate for Payer: Multiplan Commercial |
$870.75
|
| Rate for Payer: Networks By Design Commercial |
$754.65
|
| Rate for Payer: Prime Health Services Commercial |
$986.85
|
|
