|
HC CVS SAMPLING
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC CVS SAMPLING
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 59015
|
| Hospital Charge Code |
910409015
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,184.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$803.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,184.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$102.06
|
| Rate for Payer: Blue Shield of California EPN |
$64.31
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$103.68
|
| Rate for Payer: Cigna of CA PPO |
$119.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,303.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,184.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,954.62
|
| Rate for Payer: EPIC Health Plan Senior |
$1,303.08
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,942.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$190.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,658.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,587.39
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,184.62
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Prime Health Services Medicare |
$1,255.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,303.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.00
|
| Rate for Payer: United Healthcare All Other HMO |
$81.00
|
| Rate for Payer: United Healthcare HMO Rider |
$81.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,184.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,776.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,303.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,184.62
|
|
|
HC CYCLIC CITRUL PEPT AB
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC CYCLIC CITRUL PEPT AB
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913652
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$128.08 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.08
|
| Rate for Payer: Blue Shield of California Commercial |
$48.51
|
| Rate for Payer: Blue Shield of California Commercial |
$35.28
|
| Rate for Payer: Blue Shield of California EPN |
$30.57
|
| Rate for Payer: Blue Shield of California EPN |
$22.23
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Central Health Plan Commercial |
$44.80
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.95
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Prime Health Services Medicare |
$13.73
|
| Rate for Payer: Prime Health Services Medicare |
$13.73
|
| Rate for Payer: Riverside University Health System MISP |
$14.24
|
| Rate for Payer: Riverside University Health System MISP |
$14.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
HC CYCLOSPORINE A (EMIT)
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
900910933
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$65.60 |
| Max. Negotiated Rate |
$295.20 |
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$229.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$131.20
|
| Rate for Payer: EPIC Health Plan Senior |
$131.20
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$208.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$193.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
|
|
HC CYCLOSPORINE A (EMIT)
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
900910933
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.62 |
| Max. Negotiated Rate |
$182.62 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Adventist Health Commercial |
$65.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$131.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.62
|
| Rate for Payer: Blue Shield of California Commercial |
$206.64
|
| Rate for Payer: Blue Shield of California Commercial |
$99.54
|
| Rate for Payer: Blue Shield of California EPN |
$130.22
|
| Rate for Payer: Blue Shield of California EPN |
$62.73
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$147.60
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Central Health Plan Commercial |
$126.40
|
| Rate for Payer: Central Health Plan Commercial |
$262.40
|
| Rate for Payer: Cigna of CA HMO |
$209.92
|
| Rate for Payer: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA PPO |
$242.72
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$110.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$229.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.86
|
| Rate for Payer: EPIC Health Plan Senior |
$19.86
|
| Rate for Payer: Galaxy Health WC |
$278.80
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$196.80
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$295.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$18.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$100.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$208.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: Networks By Design Commercial |
$213.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.05
|
| Rate for Payer: Prime Health Services Commercial |
$278.80
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Prime Health Services Medicare |
$19.13
|
| Rate for Payer: Prime Health Services Medicare |
$19.13
|
| Rate for Payer: Riverside University Health System MISP |
$19.86
|
| Rate for Payer: Riverside University Health System MISP |
$19.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$196.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare All Other HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$18.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.86
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC CYLINDER CAST-THIGH TO ANKLE
|
Facility
|
OP
|
$925.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
950510041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$359.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$537.66
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Cigna of CA HMO |
$592.00
|
| Rate for Payer: Cigna of CA PPO |
$684.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$539.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$395.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$359.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$593.55
|
| Rate for Payer: EPIC Health Plan Senior |
$395.70
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$589.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$359.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$195.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$386.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Multiplan WC |
$537.66
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$359.73
|
| Rate for Payer: Preferred Health Network WC |
$548.63
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
| Rate for Payer: Prime Health Services Medicare |
$381.31
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$395.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$555.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$462.50
|
| Rate for Payer: United Healthcare All Other HMO |
$462.50
|
| Rate for Payer: United Healthcare HMO Rider |
$462.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$462.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$359.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$539.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$395.70
|
| Rate for Payer: Vantage Medical Group Senior |
$359.73
|
|
|
HC CYLINDER CAST-THIGH TO ANKLE
|
Facility
|
IP
|
$925.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
950510041
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$185.00 |
| Max. Negotiated Rate |
$832.50 |
| Rate for Payer: Adventist Health Commercial |
$185.00
|
| Rate for Payer: Cash Price |
$416.25
|
| Rate for Payer: Central Health Plan Commercial |
$740.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$647.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$370.00
|
| Rate for Payer: EPIC Health Plan Senior |
$370.00
|
| Rate for Payer: Galaxy Health WC |
$786.25
|
| Rate for Payer: Global Benefits Group Commercial |
$555.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$832.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$587.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$545.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Multiplan Commercial |
$693.75
|
| Rate for Payer: Networks By Design Commercial |
$601.25
|
| Rate for Payer: Prime Health Services Commercial |
$786.25
|
|
|
HC CYSTOGRAM, INJECTION
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
909000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$171.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$287.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$726.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$470.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$641.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Blue Shield of California Commercial |
$538.65
|
| Rate for Payer: Blue Shield of California EPN |
$339.44
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Central Health Plan Commercial |
$684.00
|
| Rate for Payer: Cigna of CA HMO |
$547.20
|
| Rate for Payer: Cigna of CA PPO |
$632.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$726.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$726.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$726.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$598.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.00
|
| Rate for Payer: EPIC Health Plan Senior |
$342.00
|
| Rate for Payer: Galaxy Health WC |
$726.75
|
| Rate for Payer: Global Benefits Group Commercial |
$513.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$542.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$504.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$598.50
|
| Rate for Payer: Multiplan Commercial |
$641.25
|
| Rate for Payer: Networks By Design Commercial |
$555.75
|
| Rate for Payer: Prime Health Services Commercial |
$726.75
|
| Rate for Payer: Riverside University Health System MISP |
$342.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$513.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.50
|
| Rate for Payer: United Healthcare All Other HMO |
$427.50
|
| Rate for Payer: United Healthcare HMO Rider |
$427.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$726.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$726.75
|
| Rate for Payer: Vantage Medical Group Senior |
$726.75
|
|
|
HC CYSTOGRAM, INJECTION
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
909000171
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Adventist Health Commercial |
$171.00
|
| Rate for Payer: Cash Price |
$384.75
|
| Rate for Payer: Central Health Plan Commercial |
$684.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$598.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.00
|
| Rate for Payer: EPIC Health Plan Senior |
$342.00
|
| Rate for Payer: Galaxy Health WC |
$726.75
|
| Rate for Payer: Global Benefits Group Commercial |
$513.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$769.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$542.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$504.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.00
|
| Rate for Payer: Multiplan Commercial |
$641.25
|
| Rate for Payer: Networks By Design Commercial |
$555.75
|
| Rate for Payer: Prime Health Services Commercial |
$726.75
|
|
|
HC CYSTOGRAPH MIN 3 VIEWS
|
Facility
|
IP
|
$1,261.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
909001901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$252.20 |
| Max. Negotiated Rate |
$1,134.90 |
| Rate for Payer: Adventist Health Commercial |
$252.20
|
| Rate for Payer: Cash Price |
$567.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,008.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$504.40
|
| Rate for Payer: EPIC Health Plan Senior |
$504.40
|
| Rate for Payer: Galaxy Health WC |
$1,071.85
|
| Rate for Payer: Global Benefits Group Commercial |
$756.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,134.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$743.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.20
|
| Rate for Payer: Multiplan Commercial |
$945.75
|
| Rate for Payer: Networks By Design Commercial |
$819.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.85
|
|
|
HC CYSTOGRAPH MIN 3 VIEWS
|
Facility
|
OP
|
$1,261.00
|
|
|
Service Code
|
CPT 74430
|
| Hospital Charge Code |
909001901
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$57.04 |
| Max. Negotiated Rate |
$1,134.90 |
| Rate for Payer: Adventist Health Commercial |
$252.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$448.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$288.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.75
|
| Rate for Payer: Blue Shield of California Commercial |
$794.43
|
| Rate for Payer: Blue Shield of California EPN |
$500.62
|
| Rate for Payer: Cash Price |
$567.45
|
| Rate for Payer: Cash Price |
$567.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,008.80
|
| Rate for Payer: Cigna of CA HMO |
$807.04
|
| Rate for Payer: Cigna of CA PPO |
$933.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$882.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.37
|
| Rate for Payer: EPIC Health Plan Senior |
$493.58
|
| Rate for Payer: Galaxy Health WC |
$1,071.85
|
| Rate for Payer: Global Benefits Group Commercial |
$756.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,134.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$735.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$448.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$800.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$601.27
|
| Rate for Payer: Multiplan Commercial |
$945.75
|
| Rate for Payer: Networks By Design Commercial |
$819.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$448.71
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Medicare |
$475.63
|
| Rate for Payer: Riverside University Health System MISP |
$493.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$756.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$756.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.69
|
| Rate for Payer: United Healthcare All Other HMO |
$470.69
|
| Rate for Payer: United Healthcare HMO Rider |
$470.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$448.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.58
|
| Rate for Payer: Vantage Medical Group Senior |
$448.71
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
IP
|
$2,061.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$1,854.90 |
| Rate for Payer: Adventist Health Commercial |
$412.20
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,648.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,442.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$824.40
|
| Rate for Payer: EPIC Health Plan Senior |
$824.40
|
| Rate for Payer: Galaxy Health WC |
$1,751.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,236.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,854.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,308.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,215.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.20
|
| Rate for Payer: Multiplan Commercial |
$1,545.75
|
| Rate for Payer: Networks By Design Commercial |
$1,339.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,751.85
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
OP
|
$2,061.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$845.01
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,648.80
|
| Rate for Payer: Cigna of CA HMO |
$1,319.04
|
| Rate for Payer: Cigna of CA PPO |
$1,525.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,442.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$1,751.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,236.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,854.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,308.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,545.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,339.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,751.85
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,236.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,236.60
|
| 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 |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
IP
|
$2,061.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$412.20 |
| Max. Negotiated Rate |
$1,854.90 |
| Rate for Payer: Adventist Health Commercial |
$412.20
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,648.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,442.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$824.40
|
| Rate for Payer: EPIC Health Plan Senior |
$824.40
|
| Rate for Payer: Galaxy Health WC |
$1,751.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,236.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,854.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,308.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,215.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.20
|
| Rate for Payer: Multiplan Commercial |
$1,545.75
|
| Rate for Payer: Networks By Design Commercial |
$1,339.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,751.85
|
|
|
HC CYSTOSTOMY TUBE CHG SIMPLE
|
Facility
|
OP
|
$2,061.00
|
|
|
Service Code
|
CPT 51705
|
| Hospital Charge Code |
900501165
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$111.76 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$412.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$492.37
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Cash Price |
$927.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,648.80
|
| Rate for Payer: Cigna of CA HMO |
$1,319.04
|
| Rate for Payer: Cigna of CA PPO |
$1,525.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,442.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$1,751.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,236.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,854.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,308.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$1,545.75
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$1,339.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,751.85
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,236.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,030.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,030.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,030.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,030.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC CYSTOSTOMY W DRAINAGE
|
Facility
|
OP
|
$15,205.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$169.76 |
| Max. Negotiated Rate |
$13,684.50 |
| Rate for Payer: Adventist Health Commercial |
$3,041.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Central Health Plan Commercial |
$12,164.00
|
| Rate for Payer: Cigna of CA HMO |
$9,731.20
|
| Rate for Payer: Cigna of CA PPO |
$11,251.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,643.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$12,924.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9,123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,684.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,655.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$11,403.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$9,883.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$12,924.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,602.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,602.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,602.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,602.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOSTOMY W DRAINAGE
|
Facility
|
IP
|
$15,205.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$3,041.00 |
| Max. Negotiated Rate |
$13,684.50 |
| Rate for Payer: Adventist Health Commercial |
$3,041.00
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Central Health Plan Commercial |
$12,164.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,643.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,082.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,082.00
|
| Rate for Payer: Galaxy Health WC |
$12,924.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9,123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,684.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,655.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,970.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Multiplan Commercial |
$11,403.75
|
| Rate for Payer: Networks By Design Commercial |
$9,883.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,924.25
|
|
|
HC CYSTOSTOMY W DRAINAGE
|
Facility
|
IP
|
$15,205.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,041.00 |
| Max. Negotiated Rate |
$13,684.50 |
| Rate for Payer: Adventist Health Commercial |
$3,041.00
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Central Health Plan Commercial |
$12,164.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,643.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,082.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6,082.00
|
| Rate for Payer: Galaxy Health WC |
$12,924.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9,123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,684.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,655.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,970.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Multiplan Commercial |
$11,403.75
|
| Rate for Payer: Networks By Design Commercial |
$9,883.25
|
| Rate for Payer: Prime Health Services Commercial |
$12,924.25
|
|
|
HC CYSTOSTOMY W DRAINAGE
|
Facility
|
OP
|
$15,205.00
|
|
|
Service Code
|
CPT 51040
|
| Hospital Charge Code |
900551040
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$169.76 |
| Max. Negotiated Rate |
$13,684.50 |
| Rate for Payer: Adventist Health Commercial |
$6,234.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,949.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Cash Price |
$6,842.25
|
| Rate for Payer: Central Health Plan Commercial |
$12,164.00
|
| Rate for Payer: Cigna of CA HMO |
$9,731.20
|
| Rate for Payer: Cigna of CA PPO |
$11,251.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,643.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$12,924.25
|
| Rate for Payer: Global Benefits Group Commercial |
$9,123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,684.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,655.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$11,403.75
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$9,883.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$12,924.25
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,123.00
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$653.20 |
| Max. Negotiated Rate |
$2,939.40 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,286.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,306.40
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,926.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,924.00 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,286.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,633.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,633.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,633.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,633.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
OP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,924.00 |
| Rate for Payer: Adventist Health Commercial |
$1,339.06
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,205.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: Cigna of CA HMO |
$2,090.24
|
| Rate for Payer: Cigna of CA PPO |
$2,416.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,286.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,959.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,959.60
|
| 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 |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CYSTOSTOMY W INSERTION CATH OR STNT
|
Facility
|
IP
|
$3,266.00
|
|
|
Service Code
|
CPT 51045
|
| Hospital Charge Code |
900551045
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$653.20 |
| Max. Negotiated Rate |
$2,939.40 |
| Rate for Payer: Adventist Health Commercial |
$653.20
|
| Rate for Payer: Cash Price |
$1,469.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,612.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,286.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,306.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,306.40
|
| Rate for Payer: Galaxy Health WC |
$2,776.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,959.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,939.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,073.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,926.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Multiplan Commercial |
$2,449.50
|
| Rate for Payer: Networks By Design Commercial |
$2,122.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,776.10
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
OP
|
$4,959.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$991.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,351.26
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,967.20
|
| Rate for Payer: Cigna of CA HMO |
$3,173.76
|
| Rate for Payer: Cigna of CA PPO |
$3,669.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,471.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.79
|
| Rate for Payer: EPIC Health Plan Senior |
$986.52
|
| Rate for Payer: Galaxy Health WC |
$4,215.15
|
| Rate for Payer: Global Benefits Group Commercial |
$2,975.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,463.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,148.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$964.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,201.77
|
| Rate for Payer: Multiplan Commercial |
$3,719.25
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$3,223.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$896.84
|
| Rate for Payer: Preferred Health Network WC |
$1,378.84
|
| Rate for Payer: Prime Health Services Commercial |
$4,215.15
|
| Rate for Payer: Prime Health Services Medicare |
$950.65
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$986.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,975.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,479.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,479.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,479.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,479.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$896.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
