|
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 |
$92.13 |
| Rate for Payer: Adventist Health Commercial |
$11.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$12.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.01
|
| 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 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 HMO/PPO |
$18.70
|
| Rate for Payer: Blue Shield of California Commercial |
$33.99
|
| Rate for Payer: Blue Shield of California EPN |
$22.23
|
| 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: Cigna of CA HMO |
$35.84
|
| Rate for Payer: Cigna of CA PPO |
$41.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.48
|
| Rate for Payer: EPIC Health Plan Senior |
$12.95
|
| Rate for Payer: Galaxy Health WC |
$47.60
|
| Rate for Payer: Global Benefits Group Commercial |
$33.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.40
|
| 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) Medicare Advantage |
$12.95
|
| Rate for Payer: InnovAge PACE Commercial |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$42.00
|
| Rate for Payer: Networks By Design Commercial |
$36.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$12.95
|
| Rate for Payer: Prime Health Services Commercial |
$47.60
|
| Rate for Payer: Prime Health Services Medicare |
$13.73
|
| Rate for Payer: Riverside University Health System MISP |
$14.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.60
|
| 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 HMO |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| 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 Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$51.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.66
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$218.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$124.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$203.03
|
| 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 |
$142.20 |
| Rate for Payer: Adventist Health Commercial |
$31.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$18.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.95
|
| 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 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 HMO/PPO |
$26.66
|
| Rate for Payer: Blue Shield of California Commercial |
$95.91
|
| Rate for Payer: Blue Shield of California EPN |
$62.73
|
| 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: Cigna of CA HMO |
$101.12
|
| Rate for Payer: Cigna of CA PPO |
$116.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.05
|
| Rate for Payer: Galaxy Health WC |
$134.30
|
| Rate for Payer: Global Benefits Group Commercial |
$94.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$142.20
|
| 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) Medicare Advantage |
$18.05
|
| Rate for Payer: InnovAge PACE Commercial |
$27.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$105.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.19
|
| Rate for Payer: Multiplan Commercial |
$118.50
|
| Rate for Payer: Networks By Design Commercial |
$102.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$18.05
|
| Rate for Payer: Prime Health Services Commercial |
$134.30
|
| Rate for Payer: Prime Health Services Medicare |
$19.13
|
| Rate for Payer: Riverside University Health System MISP |
$19.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.80
|
| 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 HMO |
$14.62
|
| Rate for Payer: United Healthcare HMO Rider |
$14.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.62
|
| 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 Medi-Cal |
$19.86
|
| 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 |
$2,696.00 |
| 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 |
$506.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$337.45
|
| 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 |
$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 |
$506.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$371.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$337.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.56
|
| Rate for Payer: EPIC Health Plan Senior |
$337.45
|
| 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 |
$553.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$337.45
|
| Rate for Payer: InnovAge PACE Commercial |
$506.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$452.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$452.18
|
| 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 |
$337.45
|
| 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 |
$357.70
|
| Rate for Payer: Prime Health Services WC |
$532.17
|
| Rate for Payer: Riverside University Health System MISP |
$371.19
|
| 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 |
$337.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$506.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$371.19
|
| Rate for Payer: Vantage Medical Group Senior |
$337.45
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$616.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$572.58
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$570.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.25
|
| 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 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 |
$769.50 |
| Rate for Payer: Adventist Health Commercial |
$171.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$519.24
|
| 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 |
$413.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$502.14
|
| Rate for Payer: Blue Shield of California Commercial |
$518.99
|
| 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: 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: 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: InnovAge PACE Commercial |
$427.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$598.50
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$841.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$480.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$780.56
|
| 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 |
$44.34 |
| Max. Negotiated Rate |
$1,134.90 |
| Rate for Payer: Adventist Health Commercial |
$252.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$453.77
|
| Rate for Payer: Aetna of CA HMO/PPO |
$765.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.34
|
| Rate for Payer: Blue Shield of California Commercial |
$765.43
|
| 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 |
$680.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$499.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$453.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.59
|
| Rate for Payer: EPIC Health Plan Senior |
$453.77
|
| 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 |
$744.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$453.77
|
| Rate for Payer: InnovAge PACE Commercial |
$680.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$841.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$453.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$608.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$608.05
|
| 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 |
$453.77
|
| Rate for Payer: Prime Health Services Commercial |
$1,071.85
|
| Rate for Payer: Prime Health Services Medicare |
$481.00
|
| Rate for Payer: Riverside University Health System MISP |
$499.15
|
| 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 |
$453.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$680.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$499.15
|
| Rate for Payer: Vantage Medical Group Senior |
$453.77
|
|
|
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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| 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 |
$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 |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| 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 |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,374.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| 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 |
$309.02
|
| 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 |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| 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 |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,374.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$785.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,275.76
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$1,374.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$785.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,275.76
|
| 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,210.43
|
| 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 |
$463.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$339.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$309.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$417.18
|
| Rate for Payer: EPIC Health Plan Senior |
$309.02
|
| 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 |
$506.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$309.02
|
| Rate for Payer: InnovAge PACE Commercial |
$463.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,374.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$309.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$412.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$414.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$414.09
|
| 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 |
$309.02
|
| 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 |
$327.56
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$339.92
|
| 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 |
$309.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$463.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$339.92
|
| Rate for Payer: Vantage Medical Group Senior |
$309.02
|
|
|
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 |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,141.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC 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 |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,141.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,041.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$10,141.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,793.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,411.90
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$10,141.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,793.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,411.90
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,021.65
|
| 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 |
$10,567.00 |
| 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 |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC 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 |
$10,567.00 |
| 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 |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$848.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$653.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC 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: 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 Permanente of CA Commercial/Self Funded |
$2,178.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,244.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,021.65
|
| 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 |
$4,463.10 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$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 |
$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 |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$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 |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: InnovAge PACE Commercial |
$1,272.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,307.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,136.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$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 |
$848.09
|
| 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 |
$898.98
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Riverside University Health System MISP |
$932.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$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 |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC CYSTOURETHROSCOPY
|
Facility
|
IP
|
$4,959.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
900501353
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$991.80 |
| Max. Negotiated Rate |
$4,463.10 |
| Rate for Payer: Adventist Health Commercial |
$991.80
|
| Rate for Payer: Cash Price |
$2,231.55
|
| Rate for Payer: Central Health Plan Commercial |
$3,967.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,983.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,983.60
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$3,307.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,889.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,069.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$991.80
|
| Rate for Payer: Multiplan Commercial |
$3,719.25
|
| Rate for Payer: Networks By Design Commercial |
$3,223.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,215.15
|
|
|
HC CYSTOURETHROSCOPY, W/DILATION
|
Facility
|
IP
|
$11,347.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
900501303
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,269.40 |
| Max. Negotiated Rate |
$10,212.30 |
| Rate for Payer: Adventist Health Commercial |
$2,269.40
|
| Rate for Payer: Cash Price |
$5,106.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,077.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,538.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,538.80
|
| Rate for Payer: Galaxy Health WC |
$9,644.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,212.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,568.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,323.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,023.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,269.40
|
| Rate for Payer: Multiplan Commercial |
$8,510.25
|
| Rate for Payer: Networks By Design Commercial |
$7,375.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,644.95
|
|
